USMLE Official 2018 Step 1 Experiences and Scores Thread

[Foot Fetish]

I've always wanted to start one of these...So here we go!

My stats:

M2
Test time: June 2018
Goal score: 270

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[pbrocks15]

Not sure if they were in Uworld/fa but I knew them. Maybe in class or kaplan/ rx qbank.

I see what you're saying. Just wondering - did you do Kaplan/Rx during your school year and stop come dedicated? I have a little over half of Kaplan left and not sure if I should do it or not.

 

[Lannister]

Ya, sorry, if you're getting a bloody 85! average on uworld your brain is most def not average! Either way, keep rocking-- congrats on the success so far

Haha thanks. My class rank is average and my MCAT was pretty average, I guess my talents are just more suited to step 1.

 

[afib123]

I see what you're saying. Just wondering - did you do Kaplan/Rx during your school year and stop come dedicated? I have a little over half of Kaplan left and not sure if I should do it or not.

probably doesn't matter. i did uw before dedicated started so had extra time and did these during dedicated but you can also do the reverse

 

[pbrocks15]

probably doesn't matter. i did uw before dedicated started so had extra time and did these during dedicated but you can also do the reverse

I'm in dedicated now so I guess I might try to squeeze a few in every here and there. Overall though, you felt like the material was all within UFAP?

 

[afib123]

I'm in dedicated now so I guess I might try to squeeze a few in every here and there. Overall though, you felt like the material was all within UFAP?

yes

 

[coldcase331]

If anyone can exactly guess what I'll get on step 1 on the 23rd, I'll send them a Pizza

Count me in for 258

 

[pbrocks15]

Well I reallllly hope I get to send you a pizza

256. Are we allowed a topping?

 

[Lannister]

Really tempted to order a pizza right now...

 

[QueenJames]

Does anybody have a link or score correlation for the Kaplan 8 hour full length exam that translates it into a USMLE / COMLEX score?

 

[Foot Fetish]

Doesn't it crush you to know that PDs will treat you the same as anyone else that scores a 255+ no matter how high you score? lmao

>conveniently chooses his own score as the arbitrary cut-off where scores magically stop mattering

Nice ego defense, bro!

I'm not presuming that I'll score higher or even as high as you, but you are 100% delusional if you think a 255 is regarded the same as a 270.

 

[starlite911]

Impulsively woke up this morning and decided to take UWSA2.
NBME 13: 234
CBSE: 248
UWSA1: 258
UWSA2: 256

Really hope that what they say about UWSA2 being a strong predictor is true! 26 days to go.

I scored the EXACT same on both
You're going to kill it and only improve with as much time as you have left!

 

[starlite911]

>conveniently chooses his own score as the arbitrary cut-off where scores magically stop mattering

Nice ego defense, bro!

I'm not presuming that I'll score higher or even as high as you, but you are 100% delusional if you think a 255 is regarded the same as a 270.

I don't think anyone regards them as the same, but I've been told by multiple people in different settings that as long as you score a 250+, doors shouldn't be closed to you (which is why I set it as my goal). Obviously, having a higher score can make those doors more easily crossed!

 

[pbrocks15]

>conveniently chooses his own score as the arbitrary cut-off where scores magically stop mattering

Nice ego defense, bro!

I'm not presuming that I'll score higher or even as high as you, but you are 100% delusional if you think a 255 is regarded the same as a 270.

I don't think anyone regards them as the same, but I've been told by multiple people in different settings that as long as you score a 250+, doors shouldn't be closed to you (which is why I set it as my goal). Obviously, having a higher score can make those doors more easily crossed!

I have to echo @piii a little here and a few others but I've been told by numerous PDs that Step is important but score ranges really above a 250 and even 245 are not going to make different physicians or surgeons and is rarely discussed in rank meetings. I spoke to one PD who actually said he lets their cutoff determine who he looks at but after that he doesn't care what the score is (he said that's why they've instilled a cutoff but it is reasonably "low" [who knows what that means]).

 

[DubbiDoctor]

I have to echo @piii a little here and a few others but I've been told by numerous PDs that Step is important but score ranges really above a 250 and even 245 are not going to make different physicians or surgeons and is rarely discussed in rank meetings. I spoke to one PD who actually said he lets their cutoff determine who he looks at but after that he doesn't care what the score is (he said that's why they've instilled a cutoff but it is reasonably "low" [who knows what that means]).

Well, if you look at Charting Outcomes, people with 260+ on step 1 generally match better than people with 250-259, particularly for derm. It could also be that people with stellar step 1 scores are also otherwise excellent applicants.

 

[Foot Fetish]

Well, if you look at Charting Outcomes, people with 260+ on step 1 generally match better than people with 250-259, particularly for derm. It could also be that people with stellar step 1 scores are also otherwise excellent applicants.

This is correct. I believe it was something like 96% match rate if you scored 260+ versus 86% if scored in the 250's. Like you said, super-scorers are probably more likely to be super in other domains, but either way the numbers are very compelling.

I have to echo @piii a little here and a few others but I've been told by numerous PDs that Step is important but score ranges really above a 250 and even 245 are not going to make different physicians or surgeons and is rarely discussed in rank meetings. I spoke to one PD who actually said he lets their cutoff determine who he looks at but after that he doesn't care what the score is (he said that's why they've instilled a cutoff but it is reasonably "low" [who knows what that means]).

This is a popular belief, but I think it's a bit naive. From an administrator's perspective, it's fashionable to downplay the value of Step 1, at least when speaking publicly. If a PD cared a LOT about Step 1 to the point where they basically fetishized high scores, I highly doubt they would just go around announcing that opinion so bluntly to bright-eyed medical students, whose hopes and dreams could get so easily crushed.

 

[SmallGirlBigDreams]

you are 100% delusional if you think a 255 is regarded the same as a 270.

Don't even engage with them dude. Let your phenomenal score speak for itself. I'm rooting for you. You said earlier you were getting max 12 questions wrong on NBMEs so I'm surprised by your score of <260. You still have weeks of dedicated left though and maybe it was a fluke. With school out of the picture your efforts can be more focused now. Good luck!

 

[pbrocks15]

Don't even engage with them dude. Let your phenomenal score speak for itself. I'm rooting for you. You said earlier you were getting max 12 questions wrong on NBMEs so I'm surprised by your score of <260. You still have weeks of dedicated left though and maybe it was a fluke. With school out of the picture your efforts can be more focused now. Good luck!

Much of us are rooting for each other but you still have to realize that a moderate level of confrontation is healthy. If someone isnt able to deal with confrontation appropriately then that's an issue.

 

[DNC127]

Much of us are rooting for each other but you still have to realize that a moderate level of confrontation is healthy. If someone isnt able to deal with confrontation appropriately then that's an issue.

retweet

 

[pbrocks15]

Well, if you look at Charting Outcomes, people with 260+ on step 1 generally match better than people with 250-259, particularly for derm. It could also be that people with stellar step 1 scores are also otherwise excellent applicants.

I tended to believe what's bolded, rather than the former

 

[SmallGirlBigDreams]

Much of us are rooting for each other but you still have to realize that a moderate level of confrontation is healthy. If someone isnt able to deal with confrontation appropriately then that's an issue.

I agree, but I think piii was condescending in his/her response: "I bet you'll never be in a position where you were ranked higher simply because you had a 270 and they had a 257." None of us are in the position to speak with authority over what PDs look for since we are only medical students. Everyone on SDN also preaches being "well-rounded" to get into medical school, but now that we are students we recognize that a high MCAT + GPA can offset any other part of the application more than the reverse can (low scores with stellar ECs/LORs, etc). I mention this to demonstrate that SDN's opinion is not necessarily representative of reality. It's no secret that Step 1 is the most important factor in residency applications, and to make blanket assumptions such as having a glass ceiling to the effects of a good score is naive imo. When every applicant is competitive with 250s+, the 270 is what is going to set someone apart. Regardless, I understand that a 250+ is an AMAZING score that anyone should be happy with, but if someone wants to shoot for the stars then what right does anyone else have to be offended?

Anyway, I remember you from the waitlist thread 2 years ago and I'm happy to see that you're almost at the end of your preclinical years. Best of luck to you.

 

[Krabbeman]

Don’t mean to break the tension but.... that infinity wars movie tho

 

[pbrocks15]

I agree, but I think piii was condescending in his/her response: "I bet you'll never be in a position where you were ranked higher simply because you had a 270 and they had a 257." None of us are in the position to speak with authority over what PDs look for since we are only medical students. Everyone on SDN also preaches being "well-rounded" to get into medical school, but now that we are students we recognize that a high MCAT + GPA can offset any other part of the application more than the reverse can (low scores with stellar ECs/LORs, etc). I mention this to demonstrate that SDN's opinion is not necessarily representative of reality. It's no secret that Step 1 is the most important factor in residency applications, and to make blanket assumptions such as having a glass ceiling to the effects of a good score is naive imo. When every applicant is competitive with 250s+, the 270 is what is going to set someone apart. Regardless, I understand that a 250+ is an AMAZING score that anyone should be happy with, but if someone wants to shoot for the stars then what right does anyone else have to be offended?

Anyway, I remember you from the waitlist thread 2 years ago and I'm happy to see that you're almost at the end of your preclinical years. Best of luck to you.

Bolded is truly never the case (I'll speak with authority on that) I don't think it has ever truly come to someone where they said "X scored a 262 and Y scored a 254 so we are going to select X." There are no two applicants that are so similar where they actually have to come down to the score.

EDIT: I totally missed your personal attack on me being waitlisted! I was totally waitlisted at a number of schools, but also had super early acceptances. Let's say all things worked out best, I can't complain thank you!

 

[SmallGirlBigDreams]

EDIT: I totally missed your personal attack on me being waitlisted! I was totally waitlisted at a number of schools, but also had super early acceptances. Let's say all things worked out best, I can't complain thank you!

Whoa, that wasn't a personal attack at all. I was on that thread with you, and I didn't get off the waitlist that year (I am a year behind you). I genuinely was just happy to see you doing well because we communicated a lot over that thread 2-3 years ago. I always like seeing your and bananafish's posts. What's with the hostility? I support Foot Fetish's desire to do well, I support your journey in medical school, and I support any other medical student because I am one too.

 

[pbrocks15]

Whoa, that wasn't a personal attack at all. I was on that thread with you, and I didn't get off the waitlist that year (I am a year behind you). I genuinely was just happy to see you doing well because we communicated a lot over that thread 2-3 years ago. I always like seeing your and bananafish's posts. What's with the hostility? I support Foot Fetish's desire to do well, I support your journey in medical school, and I support any other medical student because I am one too.

Aww! Actually touched that you're being that genuine! Totally read that as a "passive aggressive, I'm going to be nice to you bc kindness kills" sort of message. So I must apologize - sorry! Congrats to you on sticking through it and pursuing your dream to be a doctor.

No hostility, but just saying that regardless of where any one of us goes in life, you're going to meet people who might say something that is a tad bit hurtful. Doesn't even mean they're a bad person, but they could have a bad day and that day you happen to run into them and they ruin your motivation, drive, day etc. But your reaction to that is what matters. This happens on the forums all the time. Anyone can say anything here, but you have to also be able to take what someone says and have a level of confrontation with it. A good deal of life is going to be you ignoring the world but confrontation, I believe, is healthy and necessary (in certain ways). Not sure if I made my point clear but I don't think it's bad when someone wants to shoot super high or is suffice with a "moderate/average" score that is lower than what you desire but regardless you'll need to confront a few things in life. I think that was my initial message to whoever, I simply said that confrontation is necessary in some facets of life (something like that).

(forgive any grammatical errors, folks, gotta hit the zanki)

Edit: PS. we support you too.

 

[sharkbyte]

I find it rather weird that people elevate Step 1 to such an incredibly high pedestal on this forum. To me, there's a difference between making Step 1 the most important test of your life and the most important thing in your life. Everyone should study their butt off for this test and leave no stone unturned, but what's the purpose of having it consume your entire life? I think I saw someone on the first few pages of this thread want to get a 275 and start studying from day 1 of M1 year. How is that even a feasible goal for anyone? I'm all for "you do you" but it just seems like nonsense to me. When you're years into your career, in what measurable way will Step 1 have an impact on your career, the satisfaction you derive from your speciality, the money you make, etc? How will you even know the direct role your Step 1 score played in the residency application process? How will you know in what way or even whether it played a significant role in how you were ranked? When you match into a program, on what basis can you *selectively* pick your step 1 score as being the factor that allowed you to match at a particular hospital or in a particular city, versus other factors? Not to mention that residency is a clean slate and practically nothing that we will do in medical school matters once residency starts and you're treating patients. The neuroticism and insanity really boggle my mind sometimes.

 

[Blunt Dissection]

I find it rather weird that people elevate Step 1 to such an incredibly high pedestal on this forum. To me, there's a difference between making Step 1 the most important test of your life and the most important thing in your life. Everyone should study their butt off for this test and leave no stone unturned, but what's the purpose of having it consume your entire life? I think I saw someone on the first few pages of this thread want to get a 275 and start studying from day 1 of M1 year. How is that even a feasible goal for anyone? I'm all for "you do you" but it just seems like nonsense to me. When you're years into your career, in what measurable way will Step 1 have an impact on your career, the satisfaction you derive from your speciality, the money you make, etc? How will you even know the direct role your Step 1 score played in the residency application process? How will you know in what way or even whether it played a significant role in how you were ranked? When you match into a program, on what basis can you *selectively* pick your step 1 score as being the factor that allowed you to match at a particular hospital or in a particular city, versus other factors? Not to mention that residency is a clean slate and practically nothing that we will do in medical school matters once residency starts and you're treating patients. The neuroticism and insanity really boggle my mind sometimes.

The neuroticism though isn't completely unfounded. It's hard to deny that the higher your board score, the better your odds are at matching into the specialty and into the location that you prefer. You can be the nicest guy, be a superstar on rotations, but a 210 Step 1 will shut you out simply because you won't make the screen. Going hardcore and spending 12 hours a day studying starting in M1 is of course ridiculous because it isn't mentally sustainable, but shutting yourself away for a handful of months before your Step 1 isn't unreasonable. The whole match process of matching is complex, but if you think about it as playing odds, for certain specialties, a strong Step 1 gives you the best chance at being considered. I say for certain specialties because if your goal is family medicine, there's no reason why you should kill yourself trying to get a 260+. After you have the match letter in your hand though, the purpose that the Step 1 serves is minuscule say for possibly applying to fellowships later.

 

[MrTaco92]

Don’t mean to break the tension but.... that infinity wars movie tho

Way too many spoilers all over social media right now lol

 

[akuko2]

Ok so here was my comprehensive STEP 1 plan along with scores below:

Study hard during second yr and make sure you MASTER subjects. Spend the time learning ‘why’ things happen mechanistically because it will help you remember the small details during dedicated. You can use whatever resources you want at this point, I went over all of my school’s lectures or note sets, and skimmed Robbin’s giving myself a few days before the exam to do all the relevant UW questions, then also reviewed material which I missed Q’s on. If you get above a 90% on the block exam it’s a pretty good indicator you really understand the material. If not its ok, just make a note of that subject and you’ll know what to focus on during dedicated. It may help push you to the next level if you start a log of material that you struggle with, and just mark down specific facts that were hard for you to recall like, ‘Maternal Toxoplasmosis causes diffuse intercranial calcifications in a newborn while CMV causes paraventricular calcifications.’ Then when you get to dedicated you can refresh those tiny facts that elevate your score from good to great. You may want to use an Anki deck for this instead but that is up to personal preference.

During November I began to lightly review, so just 30 min to an hour a day of skimming FA or Pathoma and reminding myself of very important topics. During winter break I studied subjects that I felt weak on like Biostats, Anatomy, Biochemistry and some Micro. I had more time to review other organ systems during neuro which is after winter break, and my school’s last block.

Dedicated: I reset Uworld bc I did most Q’s during second yr, Did 80 Qs a day in random order timed mode to simulate real exam blocks. I reviewed every answer and took notes on what I struggled with. Then reviewed what I struggled with briefly. I finished all the Q’s about a week before my exam at 88% correct.

During that time, I also took about an NBME a week, which I highly recommend taking as many as possible. Questions on the exam are similar format and some show up verbatim. Then the week before my exam I stopped doing Q’s and reskimmed all of FA and pathoma only stopping to study things that I really still felt unsure about. Took one more NBME 3 days before the exam. And then continued to skim until I stopped studying at 12am the day before and relaxed.

Test day tips: The format of the exam is 7 blocks of 40 Q’s. You get one hour per block, and 45 min TOTAL of break time with 15 min to do a tutorial at the beginning which you should skip and it will add this time to your breaktime. If you finish a block early that time also adds to your break. I usually have a lot of extra time at the end but for STEP I made sure to be very thorough so for most blocks I ended up finishing with 3-5 min leftover.

I took a break after EVERY block. It just helped me relax and go to the bathroom, the few extra min from my blocks that ran over really helped because it was essentially ‘free break’ and I didn’t feel pressured to jump back in. I ended up taking short breaks all the way though and then had 45 min of breaktime left for the last 3 blocks so I took around a 20 min break between those just to refresh and make sure I was sharp so I could finish strong.

You have a small locker which you can go to during breaks, I brought water bottles, protein bars, a sandwich from Jimmy John’s, and a bunch of flavor-caffeine mixes. I just snacked through the exam and sipped on the caffeine to avoid that postprandial sluggishness.

Below are my NBME scores so you can see how predictive they are:

3/3/18- 236 NBME 15

3/26/18-250 NBME 18

4/2/18-246 NBME 17

4/9/18-246 NBME 19

4/14/18-240 NBME 16

4/18/18- 255 STEP 1

Useful resources: UFAP is the core of any STEP1 prep program because it works. If you have a solid understanding of the material out the gate and do all of UWorld + FA + Pathoma you will do well. Identifying weak areas and covering them will elevate your score even higher. Some resources that I liked were Dirty USMLE which is a youtube channel with videos that help with annoying things you have to memorize like childhood milestones, vaccinations, chemo side effects. CRASH by Paul Bolin, MD is also a youtube channel that is at the STEP 2 level but he explains everything in a very easy to understand way, and has clinical cases videos with questions that really help test your knowledge of certain pathology. I would listen to Dr. Bolin’s case videos while I was doing cardio, even if you don’t know the answers to the STEP 2 management questions the way he walks you through clinical cases gives you a strong knowledge of how different patho will present in clinical vignette style STEP 1 Q’s.

 

[afib123]

For all the people scoring 250+s , what specialities are you guys thinking of?
Thinking of setting up meetings with different surgical specialities (ortho, neuro,uro)

 

[akuko2]

For all the people scoring 250+s , what specialities are you guys thinking of?
Thinking of setting up meetings with different surgical specialities (ortho, neuro,uro)

I've been uro since middle of M1, lucked into a good research mentor who is a uro that let me follow him around.

 

[xxxxxxxxxxxxxxx]

Anyone have good resources for the different receptor pathways? i.e. Jak-Stat, Tyrosine kinase, etc. including which receptors are related to which pathways (like Insulin = tyrosine kinase, glucagon = GPCR)? In my opinion first aid does an absolute abominable job with organizing it all. It's super high yield but I haven't found a good summary out there.

 

[orangetea]

Anyone have good resources for the different receptor pathways? i.e. Jak-Stat, Tyrosine kinase, etc. including which receptors are related to which pathways (like Insulin = tyrosine kinase, glucagon = GPCR)? In my opinion first aid does an absolute abominable job with organizing it all. It's super high yield but I haven't found a good summary out there.

I was having the same issue.. so those questions are coming from
pg. 322 in FA 2017 "signaling pathways of endocrine hormones" and Pharm pg 230 FA 2017 G protein linked second messengers.

What I did was search all of those receptors either on google or uworld and copied the pathways and just review them. After that I started getting all those questions right in uworld!

 

[ChordaEpiphany]

The neuroticism though isn't completely unfounded. It's hard to deny that the higher your board score, the better your odds are at matching into the specialty and into the location that you prefer. You can be the nicest guy, be a superstar on rotations, but a 210 Step 1 will shut you out simply because you won't make the screen. Going hardcore and spending 12 hours a day studying starting in M1 is of course ridiculous because it isn't mentally sustainable, but shutting yourself away for a handful of months before your Step 1 isn't unreasonable. The whole match process of matching is complex, but if you think about it as playing odds, for certain specialties, a strong Step 1 gives you the best chance at being considered. I say for certain specialties because if your goal is family medicine, there's no reason why you should kill yourself trying to get a 260+. After you have the match letter in your hand though, the purpose that the Step 1 serves is minuscule say for possibly applying to fellowships later.

Yeah I think this is the right attitude. Depending on the specialty, step 1 isn't going to be worth the time and effort. If you're going for academic neurosurg or plastics or whatever, and you come from a mid-tier school, I can see doing what you have to do to give yourself every chance at a high score, but understand that this is not the MCAT. The test will be minimally like the practice exams.

Having just taken the exam, I can tell you 100% that it is random enough and weird enough that there are no guarantees, especially in the > 250 range. I got some questions on things I thought were completely overkill to study because they weren't in UFAP at all. I got questions on low-yield FA topics. Most importantly though, I got tons and tons of vague, obscure questions that were unclear and nearly impossible to answer. I was scoring 260+ on NBMEs and UWSAs towards the end and I marked 15-20 per section on the real deal. This was not so different from my UW blocks as I flag liberally, but the difference is that when I flagged stuff on the real thing, I really didn't know. All I can say is that I almost wish I just took it at baseline, prior to the pool change, with class knowledge still in my head. I was constantly trying to pull things from the back of my mind, including stuff from M1 and even prior.

Also, people who take this after a clinical year have a massive, massive advantage.

I think PDs must know how random it is. I had a few topics that were among my lowest in UW pop up over and over, while many other huge topics were massively underrepresented. I think I had 2 cardio and immuno questions on the whole thing. A friend of mine took it sitting right next to me and said she basically took an immuno exam combined with obscure anatomy.

This test wasn't designed originally to be scored linearly. Obviously accuracy isn't their 1st priority or you wouldn't have people on here getting a 240 and a 265 on the same test 4 days out both getting a 255. The base of knowledge they are pulling from isn't UFAP. UFAP is just the highest yield. The NBME sees nothing as "off limits." So UFAP just introduces you to the highest yield stuff, and on test day you get your socks blown off trying to pick between 5 study types you've never heard of on an obscure biostats question. There are experimental questions, but there were too many weird questions for them all to be experimental, and even if they throw those away, you're looking at a very small # of questions to accurately assess someone's overall understanding of the principles of medicine.

I've also heard from IM PDs are the top of the top (e.g. MGH, JHH), that the score only helps if they see you as a particular type of person. Obviously they fill their spots with geniuses, but they want a well-rounded class. You need a 260+ if you're scoring a spot in that class by virtue of your sheer brilliance and scientific acumen. 240+ is fine if they see you as a future leader and you have some serious accomplishments on your resume.

 

[BrachialComplexus321]

Yeah I think this is the right attitude. Depending on the specialty, step 1 isn't going to be worth the time and effort. If you're going for academic neurosurg or plastics or whatever, and you come from a mid-tier school, I can see doing what you have to do to give yourself every chance at a high score, but understand that this is not the MCAT. The test will be minimally like the practice exams.

Having just taken the exam, I can tell you 100% that it is random enough and weird enough that there are no guarantees, especially in the > 250 range. I got some questions on things I thought were completely overkill to study because they weren't in UFAP at all. I got questions on low-yield FA topics. Most importantly though, I got tons and tons of vague, obscure questions that were unclear and nearly impossible to answer. I was scoring 260+ on NBMEs and UWSAs towards the end and I marked 15-20 per section on the real deal. This was not so different from my UW blocks as I flag liberally, but the difference is that when I flagged stuff on the real thing, I really didn't know. All I can say is that I almost wish I just took it at baseline, prior to the pool change, with class knowledge still in my head. I was constantly trying to pull things from the back of my mind, including stuff from M1 and even prior.

Also, people who take this after a clinical year have a massive, massive advantage.

I think PDs must know how random it is. I had a few topics that were among my lowest in UW pop up over and over, while many other huge topics were massively underrepresented. I think I had 2 cardio and immuno questions on the whole thing. A friend of mine took it sitting right next to me and said she basically took an immuno exam combined with obscure anatomy.

This test wasn't designed originally to be scored linearly. Obviously accuracy isn't their 1st priority or you wouldn't have people on here getting a 240 and a 265 on the same test 4 days out both getting a 255. The base of knowledge they are pulling from isn't UFAP. UFAP is just the highest yield. The NBME sees nothing as "off limits." So UFAP just introduces you to the highest yield stuff, and on test day you get your socks blown off trying to pick between 5 study types you've never heard of on an obscure biostats question. There are experimental questions, but there were too many weird questions for them all to be experimental, and even if they throw those away, you're looking at a very small # of questions to accurately assess someone's overall understanding of the principles of medicine.

I've also heard from IM PDs are the top of the top (e.g. MGH, JHH), that the score only helps if they see you as a particular type of person. Obviously they fill their spots with geniuses, but they want a well-rounded class. You need a 260+ if you're scoring a spot in that class by virtue of your sheer brilliance and scientific acumen. 240+ is fine if they see you as a future leader and you have some serious accomplishments on your resume.

Wow. This scares the heck out of me! Based on your experience of the exam what would you would add to the normal UFAP method to be a little better prepared? I have heard many people who take it after doing their clinical year say that it was extremely helpful as well so I guess that is a bummer for those that cannot. However, what type of score do you think studying the high yield (UFAP) would get a regular student on any given test day regardless of how the information is skewed towards certain disciplines? Congrats on being done and I am sure everything worked out for you!

 

[starlite911]

For all the people scoring 250+s , what specialities are you guys thinking of?
Thinking of setting up meetings with different surgical specialities (ortho, neuro,uro)

Still keeping my foot in the door with plastics because I think the research is fascinating, but honestly, I feel like my heart is more aligned with some sort of medical subspecialty.

 

[pbrocks15]

Also, people who take this after a clinical year have a massive, massive advantage.

How do people with a clinical year have a greater advantage? I've heard this said a few times now, curious on your take now that you just took the test

 

[afib123]

Still keeping my foot in the door with plastics because I think the research is fascinating, but honestly, I feel like my heart is more aligned with some sort of medical subspecialty.

Yeah, I also really like medical subspecialties like cardiology/GI but the uncertainty of doing internal and maybe not matching into those is something I'd rather avoid. That's really pushing me towards surgical subspecialties

 

[Krabbeman]

Idk if I crush step I might take a sudden random interest in the skin

Edit: in case it’s unclear-that was a joke

 

[Mikeyyd34]

Yeah I think this is the right attitude. Depending on the specialty, step 1 isn't going to be worth the time and effort. If you're going for academic neurosurg or plastics or whatever, and you come from a mid-tier school, I can see doing what you have to do to give yourself every chance at a high score, but understand that this is not the MCAT. The test will be minimally like the practice exams.

Having just taken the exam, I can tell you 100% that it is random enough and weird enough that there are no guarantees, especially in the > 250 range. I got some questions on things I thought were completely overkill to study because they weren't in UFAP at all. I got questions on low-yield FA topics. Most importantly though, I got tons and tons of vague, obscure questions that were unclear and nearly impossible to answer. I was scoring 260+ on NBMEs and UWSAs towards the end and I marked 15-20 per section on the real deal. This was not so different from my UW blocks as I flag liberally, but the difference is that when I flagged stuff on the real thing, I really didn't know. All I can say is that I almost wish I just took it at baseline, prior to the pool change, with class knowledge still in my head. I was constantly trying to pull things from the back of my mind, including stuff from M1 and even prior.

Also, people who take this after a clinical year have a massive, massive advantage.

I think PDs must know how random it is. I had a few topics that were among my lowest in UW pop up over and over, while many other huge topics were massively underrepresented. I think I had 2 cardio and immuno questions on the whole thing. A friend of mine took it sitting right next to me and said she basically took an immuno exam combined with obscure anatomy.

This test wasn't designed originally to be scored linearly. Obviously accuracy isn't their 1st priority or you wouldn't have people on here getting a 240 and a 265 on the same test 4 days out both getting a 255. The base of knowledge they are pulling from isn't UFAP. UFAP is just the highest yield. The NBME sees nothing as "off limits." So UFAP just introduces you to the highest yield stuff, and on test day you get your socks blown off trying to pick between 5 study types you've never heard of on an obscure biostats question. There are experimental questions, but there were too many weird questions for them all to be experimental, and even if they throw those away, you're looking at a very small # of questions to accurately assess someone's overall understanding of the principles of medicine.

I've also heard from IM PDs are the top of the top (e.g. MGH, JHH), that the score only helps if they see you as a particular type of person. Obviously they fill their spots with geniuses, but they want a well-rounded class. You need a 260+ if you're scoring a spot in that class by virtue of your sheer brilliance and scientific acumen. 240+ is fine if they see you as a future leader and you have some serious accomplishments on your resume.

Wow. This scares the heck out of me! Based on your experience of the exam what would you would add to the normal UFAP method to be a little better prepared? I have heard many people who take it after doing their clinical year say that it was extremely helpful as well so I guess that is a bummer for those that cannot. However, what type of score do you think studying the high yield (UFAP) would get a regular student on any given test day regardless of how the information is skewed towards certain disciplines? Congrats on being done and I am sure everything worked out for you!

Also curious here as this is my worst fear. Didn't know about this whole "pooling period thing." How does that work in terms of scoring? I imagined the difficulty level of the question was objective based on the number of people that got that question correct/incorrect. If you're at the beginning of a pooling period, how is that adequately accessed?

 

[Foot Fetish]

When people say they had Step 2 style "next step" management questions, were they really Step 2 questions ? I feel like people hype that up, when in reality FA probably gives you all you need to answer those. I mean, there are a lot of one-liners in FA about preferred imaging modalities . I highly doubt they're asking about the nuances of the FAST algorithm for blunt abdominal trauma...it's probably more like "You suspect osteomyelitis; Next step?" And they simply want you to recall that MRI is the gold standard for diagnosis.

 

[starlite911]

Yeah, I also really like medical subspecialties like cardiology/GI but the uncertainty of doing internal and maybe not matching into those is something I'd rather avoid. That's really pushing me towards surgical subspecialties

I'm not very well-educating when it comes to residency/matching into fellowships, etc. Do you know how often that happens, even anecdotally?

 

[The Knife & Gun Club]

Update - one month out from the test. Would love some insight. Or just someone to tell me I’m not an idiot...

NBME 13: 200 - 12 weeks out, baseline before any studying

CBSE: 213 - 8 weeks out (studying with classes for 1 month)

NBME 15: 217 - 8 weeks out (back to back with CBSE)

NBME 16: 221 - 4 weeks out (today)

This most recent NBME really has me all freaked out. I’ve been in dedicated for a week and objectively have gained virtually no ground from a month ago.


My strategy has mostly been based around UWorld. I take 2 blocks a day and spend about 2 hours after each UW block reviewing in depth and making anki cards. I spends about 2 hours a day reviewing anki, split 50/50 between cards I make from UW and the pepper deck for sketchy micro + pharm. I’ve also done a good amount of pathoma and use FA consistently but don’t really “read it.”

Would love any input you all have on where I can improve.

Also, I’ve been living in my family’s Everglades fishing cabin for 8 days now and have already seen 3 alligators, so that’s a win, I guess.

 

[Rahas]

When people say they had Step 2 style "next step" management questions, were they really Step 2 questions ? I feel like people hype that up, when in reality FA probably gives you all you need to answer those. I mean, there are a lot of one-liners in FA about preferred imaging modalities . I highly doubt they're asking about the nuances of the FAST algorithm for blunt abdominal trauma...it's probably more like "You suspect osteomyelitis; Next step?" And they simply want you to recall that MRI is the gold standard for diagnosis.

This has been my belief all along. I don't believe I've ever come across anyone who specifically attempted to study step 2 level management.

 

[Rahas]

I had a couple OB questions that definitely were not in any UFAPs/Step 1 material. One question involving hospital equipment/devices I've never used and was not familiar with. One question involved fluid management. One required knowing ultrasound technique and I only knew because my school has an ultrasound lecture for all organ systems. And probably a few more. You can get them down to 2 possibilities with logic for the most part. There were a handful, but not enough that you couldn't get in the 250s if you got them all wrong.

What would you feel is a more accurate description of your experience, that step 1 now includes step 2 management questions, or that these questions were part of the standard 2-3 in each block that people say were stuff they'd never / could never study for? Since the subject matter of these 2-3 questions varies from person to person (I've heard everything from impossible micro to impossible biochem to impossible anatomy only a surgeon could know etc).

My idea has always been to first secure the 35/40 questions UFAP covers, then allow solid basics to make educated guesses in the remaining 5. This is pretty much the way to break 190/200 in any NBME at least.

 

[afib123]

I'm not very well-educating when it comes to residency/matching into fellowships, etc. Do you know how often that happens, even anecdotally?

I am not too sure. I know that GI is the most competitive IM fellowship followed by cardiology. A google search showed up GI having a match rate in high 60s and cardio have a match rate in the 80s. If you go into a prestigious IM institution for residency, your chances go up dramatically is what I understand

 

[afib123]

That's why I said you should talk to residents. If I remember correctly, the average step for someone matching cards was 240-245. The people who were competitive from the beginning are competitive throughout. And if you look at charting the match, 631 people matching IM have above 250. There are 30-50 people in most IM intern classes, so that means the top 20 programs have enough space for the 631 with much room left over. I think all the top 30 programs have 95-98% fellowship match rate. You will have to work, but I don't think it is as bad as you think

Prestige isn't always necessary either. Connections are important. Some programs hold spots for their residents.

Yes I agree. If you love the IM subspecialties and don't want to do anything else, you have a pretty good shot at them especially with a high step 1 score which will allow you to match into a good institution. GI is a little tougher than cards, but definitely doable.
But, luckily, I like multiple things and surgical subspecialties definitely interest me.

 

[The Knife & Gun Club]

Dang dude, sorry about the stagnation. Are you improving in uworld (also do you mind if I ask what percent you have, as my goal is national avg so your nbmes are around what I'm shooting for haha)? If so, maybe it's just a NBME question style deal? I've only taken two and both were before I did much uworld so can't provide much more of a personal anecdote than that. I can say, though, that I have three close friends who all had similar nbmes to what you have and the nbmes under-predicted for all 3 of them. Hopefully that provides some giddy-up, so to speak .

And, yes, that is a win. I think you should name them and make one a step 1, everglade cabin mascot.

Thanks

Yea the stagnation is what worries me - I wouldn’t even be that broken up about 220. I’m going for EM, so a sky high step isn’t really a necessity. It’s just the idea that I’m not improving that bothers me .

My UW average is around 65% (52nd percentile). I’m hitting in the 70s on blocks pretty consistently, up from 50s when I started. So I feel like I’m making progress on UW, maybe it’s just not translating.

Also: 4 alligators! I saw another one while eating lunch.

 

[sharkbyte]

Took NBME 15 today, scored a 242! Improved from a 228 on NBME 13. The NBME questions really have a different feel from UW...

 

[pbrocks15]

I can't comment on whether it "now includes" Step 2 stuff because I've only taken it once and only this year. These topics, however, were Step 2 topics and are in FA for Step 2 and Step Up to Medicine and UWorld for Step 2. These were not wtf questions (I only had one of those). Like I said, these were questions where you can make educated guesses, but you'd probably know straight up if you already finished 3rd year.

(I actually think the impossible anatomy and micro stuff is the exaggeration. Most of my anatomy was not in FA, but definitely a level of detail reasonable to expect us to know)

How the hell are we supposed to know these then!? Lol

 

[Krabbeman]

Took NBME 15 today, scored a 242! Improved from a 228 on NBME 13. The NBME questions really have a different feel from UW...

How far out dude(tte)!!?

Congrats