Hi everyone, I've been reading SDN regularly since starting Step 1 prep, and have HUGELY benefited from the experiences a lot of people post on here (it's also crazy how high the scores reported on here are, and I don't think newcomers to SDN really understand how much higher than the average scores reported on here are). That being said, I just joined to share my experience with Step 1. I got my score back yesterday and writing out your experience really puts things in perspective. Will basically put my entire experience, sorry if you don't want a biography, but maybe someone will find it useful apart from me.
I am an IMG from Europe with a dual citizenship of US and my country where my medical school is in Europe. I think I've understood the importance of Step 1 since week 1 of medical school, and have worried about it enough. I am currently 5/6 years and will be applying for residency next fall, this general surgery in mind. I came into the whole USMLE game with a Step 1 score goal of 250's.
Anyways the earliest I could take Step 1 was after my 4th year (after ALL basic science courses were done). I used BRS books and Goljan during the 4 years of basic science.
6 months out: fast forward to March 2013, I read Goljan Patho once again, and then re-read it by June. Took my first NBME just to see where I was at and it predicted a 178 (Wasn't surprising to score low but was disappointed that I wasn't closer to 200 range). I scheduled my exam for late August, just before school started.
3 months out: Started June and used a few books that Pollux (
http://forums.studentdoctor.net/threads/preparing-for-usmle-in-australia-my-experience.597742/) recommended during this time. HY Cell/Molecular Bio, BRS Biochem, BRS Anatomy, HY Neuroanatomy, and read FA cover to cover slowly in June. By July I was working on UWorld and FA only and my averages were slowly going up. I always did random, timed 23 or 46 q's. I started in low 50's, then within a week or two was scoring in 60's. Took NBME 12 early August and got a 232 (I was pleased as I knew I was in the general area of where I'm supposed to be/ no major holes in knowledge!) Took UWorldSS1 a week later and got a 250. Finished UWorld with a 64% avg. Next, I took NBME 7 one week out and got a 242. This made me hesitant as, while most people reported on here NBME under predicting esp. in this range, there were many cases of NBME being accurate. As an IMG Step 1 is so crucial, and I made the difficult decision to go back to school in Sept, and wait until Dec/Jan 2014. I ended up scheduling for med-Jan due to family reasons (1st half of Jan is a no-go). During the fall I did USMLERx (77% overall) and then in December did UWorld for the 2nd time (83% overall). This put me at 95th percentile on UWorld but I felt like it was inflated as I resubscribed so my history was clean. To be honest, I found USMLERx to be the best improver of my knowledge as a whole. I found that the older descriptions of it were outdated and found a lot of well written challenging questions on there. I agree that UWorld is most similar to real exam, but USMLERx in my opinion is a great bank to hammer a lot of concepts home not just from FA.
8 days out from test I caught a nasty flu (a major downside when choosing to take USMLE in the winter months, it happened to me so beware!). I literally couldn't study. All I did was sacrifice each day of FA review thinking it would speed my recover, but it didn't. Ended up moving me exam to Jan late Jan to a different testing center further from my house, which was disappointing but ended up being no big deal. This whole ending was very anticlimactic. My girlfriend was already sad that I moved my exam from Aug, and 4 more months of seclusion to mid Jan and then had to move it by another week. Agh, so exhausting. That last week was tough to motivate myself to study. Took two more NBME's and got 242, and 245 on them (disappointed and exhausted). Went into the exam confident due to my UWorld averages! I was definitely expecting 240+. All in all, because I had to move my exam several times and the whole process would get delayed, I read FA 7 times cover-to-cover. Memorized every table and diagram by memory and understood every concept in that book.
Test Day: sleeping was difficult the night before. I made the difficult decision to use a sleep aid the night before (hoping that taking my prescription benzo and the slight morning grogginess the next day would be easier to deal with than a night of literally ZERO sleep which is what I experienced two nights before). I took a 1:30PM test which I found very valuable. I always did better on Uworld during these hours. The hardest part of the exam is the wait in the waiting room right before the exam, and the first 5 minutes when you type in your ID and the 3 or so clocks start counting down. You look at the questions with shear fear and after a few questions you're sure you got right you realize your resources you used war eon par with what they want and you get in a rhythm. I didn't find fatigue or mental exhausting to be a major issue like some people complain of. Did tons of pushups during breaks and jumping jacks and took a break after every block except first. Had 15 min break time left at end of day. I finished each question block at the buzzer, which was very surprising. I don't think I ever finished a UWorld block with less than 10 min left. I ALWAYS finished early. This is a testament to how long and hard the questions are (and difficult the pressure of reasoning something in 10 seconds) is on the actual test. I also found that only about 50% of the exam was something you can learn or memorize in FA or any other book. I found that almost half of the test was a test of intelligence and reasoning. Something that you can practice but something that time and time again if you're not a certain level of smart you will just get those wrong. These were questions that involved pharmocokinetics and analyzing research (at least 5-10 questions asked about research models or analysis!). When I see people with these scores of 265+, I can tell you from experience that not only did they put an immense amount of time into getting almost all the questions that involve fact regurgitation correct, but they also have the ability to think and reason that the other 95% just don't have.I'm a firm believer that these people will score higher than someone of average intelligence who prepped nonstop for 5 years. I also found that a lot of topics stressed in FA were not stressed on my exam like drug side effects, and random characteristics of diseases which are highly tested in UWorld. Topics I found to be surprisingly numerous on my exam: Leukemias, research models, listening to murmurs, genetics, P450 drugs interactions! Everything else was fair game.
I finished exam exhausted but hopeful, although I was unsure of result. I thought that actual exam was harder than Uworld, and harder but similar in nature to NBME questions. 3 weeks of waiting was brutal.
Actual Step 1 Score: 251
I am pleased as I accomplished my goal of 250+, but a tiny bit greedy as I honestly thought that if I got slightly lucky on a few questions I could get near or above 260. Luck is definitely a factor on this test! So many questions are educated guesses, so luck of the draw on 5-10 q's might be the difference between 250 and 260. Anyways I am pleased that the beast is over with and I can concentrate on rotations, Step 2, family, private life, have a social life again. In case you are wondering whether I am glad that I moved my exam from Aug to Jan, I would say yes. I think my score would have been slightly lower but similar with 3 months less of review, but I think the importance of this exam for IMG's (i.e. you fail or score sub-200 and you're done) made me want to exhaust myself just for slightly more of a guarantee that I would do well. If only to sleep better at night and know I did everything I could.
My recommendations based on my experience: read Goljan patho during patho block for MS2's in US. Don't ever bother with recommended textbooks. The HY and BRS books are what make you a well rounded Step 1 takes/doctor overall and not knowing every ******* detail of for instance neuroanatomy. That's for PhD students. Don't worry too much. Enormous gaps in knowledge can be covered in a few months. Eat well and exercise is as important as actually studying. Don't do what some people do in their dedicated 8 weeks of review and neglect your body. I learned this the hard way. USMLERx is very useful in addition to UWorld (if you want to do a bank late in MS2, then do it and leave Uworld for last). Memorizing every last work of FA isn't as useful as people say it is. You WILL hit your score limit, more time will only exhaust you and make you do worse. To get 260+, you have to have that it-factor, which most people don't have and any amount of reviewing won't get you there. Another thing which I found is that where you went to school doesn't mean JACK **** for what you will get on Step 1. Yes, Harvard med students almost all pass, but it's all about the caliber of the individual not where they went to school. You can't look at my experience and say oh look I'm an IMG from Europe, so I can get a 251. WRONG! You might get a 251 but I found that it has little to do with your school and education and more to do with your intelligence, study plan, motivation, and demeanor. Apart from that relax, chill the **** out, doing something to relax yourself like watching movies and tv is ok. Don't worry that your classmates are studying 16 hour days. Study 8 solid hours and hang out with your family, eat, exercise the rest, and I guarantee you'll do better than if you were to do the ******* kamikaze 16 hours a day. People in your year will make you feel like it's all a rat race and you have to study all the time but it's total BS. It's all about the whole process, not just study quantity. Also, sex if you have a partner, or self-release is important. At least it was for me. Be patient in this entire process, getting your target Step 1 score is such a journey, and while I didn't get 260+, I am satisfied and at the 90th percentile (something that will not preclude me from interviews for any specialty). Sorry for rambling, but I found typing this out to be a good way to gain perspective on the last year of my life.
