Long post because previous users posts have helped me so much in prepping for this exam and want to give back. Hope any insights I have will be helpful
NBME 16- 207 (baseline), 10 weeks out
NBME 15- 221, 8 weeks out
NBME 13- 248, 5 weeks out
UWSA 1- 262, 4 weeks out
NBME 17- 240, 3 weeks out
UWSA 2- 260, 2 weeks out
NBME 18- 248, 1 week out
Free 120/117- 91% (3 days out)
uWorld 1st pass- 76% random, timed
Final score: 257
Resources:
uWorld x1.5 (redid all incorrects + marked questions)
Kaplan ~800 questions
USMLE Rx ~300 questions (most before dedicated)
First Aid (1 pass before dedicated, referenced throughout dedicated, reread some chapters I felt weak in)
Pathoma (1 pass preclinicals, just 1st 3 chapters + heme/onc + repro path during dedicated)
Boards and Beyond (biochem, immuno, repro, and any weaknesses)
Anki (personal deck)
Sketchy Micro + Pepper deck
Sketchy Pharm + Pepper deck
Strategy:
Pre-dedicated: First I should say I have the curriculum where you do 1.5 year preclinicals, 1 year clinicals, then take step 1. During pre-clinical years I essentially followed First aid + pathoma along with my classes, didn’t do any qbank. Did one full pass of sketchy micro during this time, too, didn’t touch sketchy pharm. Half-way through pre-clinicals, I realized how incredible of a learning tool anki was, and it became my primary learning modality. I essentially took all notes I deemed relevant for step 1 using first aid as a guide into anki. My school is pass/fail, so following this strategy and just going through class slides right before a test, I found I was doing fine in school while also preparing for boards. When clinical year started I tried keeping up with my anki reviews but found I was not able to. What I ended up doing was abandoning my anki deck and focusing just on clinicals/ learning for my rotation. By the time clinical year ended I actually knew a decent amount of info in the organ systems section of first aid, however forgot basically everything from the basic science chapters. I had an easy rotation my last month of clinical year and started a little step 1 review. I essentially needed a good way to relearn biochem/immune/path material. Boards and beyond was invaluable to relearn biochem/immune and is the reason I starred these on my final exam breakdown. I followed B&B/FA for those two subjects. For path I redid first 3 chapters of pathoma, which is absolutely gold as everyone says. (I would later only use pathoma for certain topics, like repro path or Heme/onc, but otherwise didn’t touch it again during dedicated.)
Dedicated: I started uWorld at beginning of dedicated. My entire study strategy revolved around uWorld really. I would start out doing 1 block/day and working up to 2 blocks a day later in dedicated. Whatever came up in uWorld that I wasn’t comfortable with I would learn about in FA and put it into anki! That means anything that was marked or incorrect ended up in my anki deck. Any details I thought were important in explanations I put into my anki deck (meaning I always read all answer choices/explanations, even for corrects). If there was an answer choice I didn’t recognize that I deemed important I put into anki (eg, an identifier that I couldn’t link to a disease, like webbed neck and turners). What resulted was I ended up knowing uWorld really, really well. I know this because when I did repeats on my incorrects I was scoring 80’s-90’s. Another part of my strategy is I would study entire topics based on a question. If I miss a question on an oligodendroglioma, I’m learning all the adult brain tumors, cause I’m going to study each answer choice alongside first aid. This is what makes uWorld and First aid such a powerful combination. Learning FA in the context of uWorld was the key to me doing well. If I had a hard time learning from these I would go to B&B and watch a video on the topic, which basically explains FA to you so its incredibly helpful. One problem with this strategy was taking notes into anki takes a lot of time (started out taking 3-4 hours to review a block), but it would save me time in the end because I wouldn’t have to worry about reading that section in first aid again. I started uWorld scoring in 60’s consistently, worked my way up steadily to scoring 80’s-low 90’s at the end of dedicated.
Micro/pharm- I knew lots of sketchy micro pretty well, but forgot lots of bugs I hadn’t though of during clinical year (like all the parasites, most viruses…). I knew a lot of drugs in sketchy pharm from clinical year but most of it was new to me. Pepper’s micro/pharm decks (which are just sketchy put into anki form) are another invaluable resource. For micro I didn’t even rewatch videos, I just unsuspended cards and learned them directly for bugs I felt weak on. For pharm I actually had to watch many of the videos for the first time since it is so detailed, and then use Pepper’s deck for each video I watched. There are details in FA not found in pepper decks or sketchy, so I would edit his deck to cover these. There are also things I didn’t care to study (like if a drug was PO or IV) so I suspended those. These resources were more than enough for every single pharm/micro question I got on the test. FA also has a systems micro section that you should go through before the test.
I did some USMLERx before dedicated to get a taste for exam questions. I did a few at the beginning of dedicated but quickly realized it wasn’t helping me, because USMLERx is just FA directly converted to question form, and I was already going through FA with uWorld. This is where Kaplan came in. I used it for supplemental questions. Whoever started the rumor that Kaplan is too low yield to be helpful should be shamed because it was incredibly useful to have a resource that actually tested my knowledge on certain subjects the way uworld does without making me regurgitate first aid. There are a few questions on my actual exam that I got right solely because I learned it from Kaplan (I know this because I’d have it in an anki card with a Kaplan diagram/explanation pasted in). Sure there are some silly questions but I feel like you can just ignore those and use Kaplan to hammer out any weaknesses you have.
I walked into the actual test worried about how difficult it would be but honestly it felt like I was doing uWorld blocks with some NBME mixed in. Don’t get me wrong, there would be some questions that were hard, and some rando questions where I literally couldn’t tell you what each of the answer choices were, but for 90% of my exam it felt very doable. Some questions had very long vignettes with lots of data (like an EKG + laundry list of labs), but honestly after clinical year these didn’t faze me. If anyone asks whether clinical year helps or hurts you for boards, I honestly think it helps so much it almost doesn’t feel fair. Clinical year I felt I really synthesized a lot of physio and pathophys that helped me on the exam, and reading labs or identifying syndromes became second nature (eg, cardiogenic shock, sepsis, ARDS, post viral pneumonia). You forget things like biochem and immuno, but I was lucky enough to have the time to relearn those for the exam. Some questions would intentionally blur the line between two answer choices by giving characteristics of different disease in the vignette’s, and that’s where thinking about what is more likely in the patient based on demographics, risk factors, etc comes into play. Sometimes they word answer choices in a way that it doesn’t feel good to pick the right answer and you are very tempted to choose the wrong one because it sounds better or uses a buzz word you’re more comfortable with. However that’s where your practice questions come in and you’ll inevitably develop your ability to rationalize the differences between answers. Sometimes the questions are so easy, you question whether it was added to your exam on accident or if it’s a trick question (eg, 50 y/o M, heavy etoh use in past, acute onset epigastric pain radiating to the back, what’s elevated their blood?)
In the end, I figured i'd score between nbme 18 and UWSA2, and would've been happy with anything in the range.
