I've been lurking around here for a couple years now and found many of the previous years' USMLE experiences very useful. I just thought I'd share my experience with the exam (taken in early June with the score report released 2 weeks ago). Overall, I ended up with a 271 without going through FA, primarily since the key to my preparation was Firecracker, which I was able to master about 80% prior to the exam. So I'm hoping this will be useful for anyone else considering "replacing" FA with Firecracker before starting MS2.
Here's a brief outline of my Firecracker preparation starting summer between MS1 and MS2:
1. Summer break: Flagged/mastered all anatomy, histology, and physiology (except the neurology section) in Firecracker.
2. Fall semester: Annotated 9 chapters of Pathoma. Flagged/mastered heme/onc., endocrinology, general pathology, neurology, and each organ system's pharmacology as covered in class lectures. Approximately 35-40% done at this point.
3. Winter break: Finished rest of Pathoma (approximately 2 chapters a day). Flagged/mastered all pathology questions for cardiology, pulmonary, & GI. Approximately 50-55% done at this point.
4. Spring semester: Flagged/mastered Derm, Rheum/ortho, nephrology, and reproductive organ systems along with all remaining pharmacology topics as covered in class lectures. Only organ system not covered is psychiatry. Approximately 65-70% done at this point. Had about 3.5 weeks of dedicated time after finals.
5. During the 2 weeks following finals: Flagged/mastered all embryology, microbiology, and immunology along with any updated/new pathology or pharmacology topics that appeared via Firecracker content updates. Approximately 80% done and stopped Firecracker at this point. The only topics remaining that were not covered on Firecracker were: biochem, molecular bio, cell bio, genetics, behavioral science, and psychiatry (organ system). For these topics, I used a combination of biochem flash cards (Lange), class lecture notes on molecular/cell bio & genetics, Kaplan videos on behavioral science (cannot recommend this highly enough for behavioral science & psychiatry!), and Qbanks.
Pathology: I already mentioned Pathoma, but I was also listening to Goljan audio pretty much throughout the entire spring semester and ended up covering his entire set of lectures 5 times over the semester while not listening to it at any time when I was home. It's amazing how much Goljan you can cover outside your home just by listening whenever you have some free time (eg. driving, standing in line, ignoring lunch talks, etc.). I also read Goljan's RR once just before the Pathology NBME during finals and once just before taking the exam.
Qbanks
1. UW: I would only do random timed blocks of questions based on Firecracker topics that I had already covered, starting in the fall semester of MS2. Scored approximately 80% per block and had about 25% of the qbank done by the end of fall semester. During the spring semester, I would do periodically do random timed blocks that included all the organ systems (since I had already finished pathoma) and would average ~80% per block. By the time finals were over, I still had about 50% of UW questions remaining. I'd be able to cover an average of 5-6 blocks per day (now regularly getting >90% per block) and finished UW by the end of my 2nd week of dedicated studying with a cumulative average of 87%.
2. Rx: I would periodically do Rx questions starting in the spring semester of MS2. Overall, I felt that this particular qbank would regularly have frustrating errors/contradictions vs. other sources/qbanks but it seemed to be a good way of covering FA material without ever reading through FA. I stopped doing Rx questions (about 70% done) during the 2nd week of dedicated studying since I was regularly getting 90-98% and didn't really feel like it added any other high-yield concepts to my preparation. I also found the errors and lack of explanations in some Rx questions to be quite annoying.
3. Kaplan: I only did the questions on behavioral science. Combining that with the Kaplan videos on behavioral science ended up making (by far) my weakest subject into one of my top 3 subjects on the exam.
NBMEs
#12 (8 weeks out): 243
#13 (7 weeks out): 256
#7 (6 weeks out): 262
#11 (2 weeks out): 256
#15 (1 week out): 260
#16 (1 day out): 269
UWSA 1 (4 days out): 87%
UWSA 2 (3 days out): 90%
Free 138 (1 days out): 93%
As for the actual exam, I actually felt fairly comfortable for the most part, so I don't really remember many specific questions except for several fairly ridiculous questions that I later looked up, including a couple on allergic bronchopulmonary aspergillosis, 1 on inpatient decubitus ulcer prevention, 3 or 4 on lysosomal storage diseases (yikes!), 2 on nutrition (not your standard vitamins/metals/marasmus/kwashiorkor/etc. type of questions, but ones asking which particular food is most appropriate to add to the patient's diet), 1 on some skin condition I still can't really figure out, and 1 on thermal injury (glad I read Goljan RR for that one). I also had a brainstem lesion localization question but the image was a sagittal view of the specimen which made it a little bit tougher. There were a number of behavioral science (what would you do/say next?) questions that were fairly difficult (sometimes with >=10 answer choices) but can be narrowed down to 2 almost equally valid choices based on various principles that can be applied, but I felt that the Kaplan behavioral science videos and qbank questions really helped me further narrow it down to the single best choice.
Overall, I thought that the first 2 blocks were probably the toughest for me mostly because I started early in the morning and I felt like it took a block or so to really get "warmed up" into USMLE-mode despite having had plenty of caffeine before and during the exam. There were also some really long hematology question stems that took up quite a bit of time during that first block. Fortunately, I was still able to finish averaging about 10 minutes remaining to review all the questions I marked (probably ~10 per block, with a very low threshold for marking). Took my first break after the 2nd block and I felt like I was basically able to breeze through the next 3 blocks without too much trouble, with about 15 minutes remaining after each block to review marked questions (only ~5 per block). Took my second break for lunch after block 5 and finished the last 2 blocks with a short break between them. The last 2 blocks seemed slightly more difficult than blocks 3-5 but still seemed fairly manageable with about 10-15 minutes remaining to review marked questions (~5-10 per block). I would probably estimate getting ~90% of the questions correct, with the actual exam's difficulty being pretty much the same as UW (blocks 1-2 were more difficult, blocks 3-4 were like the NBMEs, and blocks 5-7 were about the same). Interestingly, the NBMEs ended up underestimating my score probably because of a couple of reasons: 1) After a certain point, you have almost no room for error in order to score above 260 on the NBMEs, 2) the actual curve is probably more generous than the NBMEs, and 3) I felt like most of the questions on the NBMEs were either very straightforward or something obscure I hadn't studied yet or never heard of before, with relatively fewer questions (compared to UW) requiring the kind of long and difficult reasoning found in many questions on the actual exam.
So in the end, I would say that the key points to my preparation were:
1. Firecracker: This was probably the SINGLE most important source of preparation for me (yes, even more than UW or other Qbanks). I also made sure to annotate a lot of UW and Pathoma material into the respective topics in Firecracker. Its spaced repetition model of studying really works as long as you have the drive to keep going through all the questions that had been rescheduled along with regularly adding new topics/questions to your "bank" of questions. It's also important to get a good intuitive sense of how well you remember the topics covered in the daily review questions in order to reschedule those questions at just the right time to prevent forgetting them. The Firecracker/Pathoma combo that I did over the fall semester and winter break was probably the only reason I was able to consistently score ~80% on random timed block throughout most of my first run through UW. By the end, I felt like I couldn't possibly forget any of the topics I covered even if I tried since I'd already seen those topics come up so many times during review. On the real exam, I actually lost track of how many questions I was able to reason out purely because of a random fact that happened to pop into my mind when recalling the relevant topics in Firecracker.
2. Addressing and keeping track of weaknesses: I definitely suggest taking an NBME 2-3 months out under exam conditions in order to get a good idea of any weaknesses that needs to be addressed. The first NBME I took ended up exposing huge weaknesses in biochem, microbiology, immunology, cell/molecular biology, and behavioral sciences but the other areas had been fairly solid (with pathology being the strongest). As a result, I felt fairly comfortable as I really started to focus on the weak areas over the next 7 weeks (using the sources listed above) at the expense of studying more pathology. Eventually, I was able to build up these weaknesses into areas of strength to the point where they were among my best subjects in NBME16. Fortunately, I also ended up leaving myself with just enough time to read through Goljan's RR one more time during the week leading up to the exam. This process of tracking/addressing weaknesses was probably only second to Firecracker as the most high-yield studying I've done for Step 1. Whereas Firecracker/Pathoma/Goljan audio got me to a 243 on NBME 12, the focused/targeted studying was able to get me the rest of the way to the point where I was regularly scoring >90% on my last ~500 UW questions and 90-98% on Rx questions.
3. Qbanks are about quantity, not quality: This would probably be the other way around for many people using UW as a learning tool (reading all explanations, annotating, etc.), but I used UW mainly as an assessment tool from the very beginning. I planned on building up a solid foundation of knowledge using Firecracker, Pathoma, and Goljan, and then tackling UW while addressing and tracking my strengths/weaknesses along the way. Otherwise, if I really had been using UW as a learning tool, it would've been absolutely impossible for me to cover half of UW in just the first 2 weeks of dedicated studying.
Anyway, this was how I was able to get a 271 without really reading through FA. I probably don't have all that much to say about how best to study w/ FA since I only used it as something to compare with in case I found any potential errors or discrepancies in the other study materials. Nonetheless, I'm certainly NOT discouraging anyone from studying with FA since it is still probably the highest yield resource for step 1. I just thought I'd share an alternative way of preparing for it that seemed to work for me.
