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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[Foot Fetish]

It's simply not realistic for the vast majority of people to memorize every single word of a 700+ word review book. But doing so would constitute an interesting experiment, offering insight into the percentage of step 1 questions that are covered by first aid. I curious as to whether memorizing firstaid - and understanding the concepts therein - would net a 265 or 270. Surely test-taking skills must influence performance as well, though. How have your latest practice tests gone?

Well, I got a 262 on UWSA1 today, which I am not too thrilled about because it is my understanding that UWSA1 tends to over-predict. Interestingly, the vast majority of my incorrects were extremely careless errors. For example, there was one question where they gave you the pO2 in the different chambers of the heart, and you had to simply identify that there was an ASD (a very easy problem which I solved many, many times in different q banks), but I assumed they were giving chamber pressure (also measured in mm Hg), thus turning it into an unintelligible problem...In another question, it asked for the location of the slowest segment of the cardiac conduction system, and I misread it as asking for the fastest. Another one was a simple biostats arithmetic error that my 8 year-old nephew could solve.

I don't know if I should be glad that I don't have any content knowledge deficiencies or if I should be discouraged that I am continuing to make the most idiotically careless errors.

And in regard to your comment, I honestly feel that my knowledge of FA at this point approaches 99%+. In addition to fully maturing Zanki, which was already extremely comprehensive to begin with, I went through FA page by page and made additional cards of every single detail that I was unfamiliar with (i.e. not covered in Zanki, which surprisingly came out to hundreds of cards), including things that most people never even see, like a 1 word label of an obscure enzyme in a diagram that needs to be searched on Wikipedia (e.g. protein kinase R on page 201).

Indeed, my threshold for deciding what to memorize is extremely low. It's only things like the Kozak consensus sequence being (gcc)gccRccAUGG (from UW) that I really hesitate on. However, when it comes to FA, I am confident I will be able to tell you with extreme accuracy what % of my exam could be answered with FA.

 

[DubbiDoctor]

Well, I got a 262 on UWSA1 today, which I am not too thrilled about because it is my understanding that UWSA1 tends to over-predict. Interestingly, the vast majority of my incorrects were extremely careless errors. For example, there was one question where they gave you the pO2 in the different chambers of the heart, and you had to simply identify that there was an ASD (a very easy problem which I solved many, many times in different q banks), but I assumed they were giving chamber pressure (also measured in mm Hg), thus turning it into an unintelligible problem...In another question, it asked for the location of the slowest segment of the cardiac conduction system, and I misread it as asking for the fastest. Another one was a simple biostats arithmetic error that my 8 year-old nephew could solve.

I don't know if I should be glad that I don't have any content knowledge deficiencies or if I should be discouraged that I am continuing to make the most idiotically careless errors.

And in regard to your comment, I honestly feel that my knowledge of FA at this point approaches 99%+. In addition to fully maturing Zanki, which was already extremely comprehensive to begin with, I went through FA page by page and made additional cards of every single detail that I was unfamiliar with (i.e. not covered in Zanki, which surprisingly came out to hundreds of cards), including things that most people never even see, like a 1 word label of an obscure enzyme in a diagram that needs to be searched on Wikipedia (e.g. protein kinase R on page 201).

Indeed, my threshold for deciding what to memorize is extremely low. It's only things like the Kozak consensus sequence being (gcc)gccRccAUGG (from UW) that I really hesitate on. However, when it comes to FA, I am confident I will be able to tell you with extreme accuracy what % of my exam could be answered with FA.

It sounds like you've basically mastered the content, but suboptimal test-taking skills are preventing you from achieving extremely high scores. Best advice I can give is to read every question and answer choice slowly and carefully, paying careful attention to words such as "increase," "decrease," "higher," "lower," etc. Make sure you understand exactly what the question is asking and the answer choice is saying before you choose one. Double and triple check all questions involving arithmetic. Of course, to be extra careful when reading questions, you'll need to be able to reason and use logic quickly, in order to finish with enough time.

 

[ERDOC555]

Do you guys think it's overkill to memorize every detail in UWorld? For example, I just encountered a question in UWSA1 where the explanations for the wrong choices go into several uncommon porphyrias, such as variegate porphyria and congenital erythropoietic porphyria. Judging by the fact that most people balk at even memorizing the details of FA, I am pretty sure that 99.9% of people aren't trying to learn the uber-minutiae of UW. Even I skipped these minutiae on my first pass months ago, but now, 2 weeks out from the big day, I am trying my hardest to memorize every last word on my second pass. Usually each question will contain at least one esoteric gem, usually buried in the explanations for the wrong choices. I highly doubt these will show up on my test, but then again you always hear about those "wtf questions" and the so-called "experimental questions" (which, on test day, will be indistinguishable from really random, difficult questions that actually do count).

I think it's for sure overkill. If any of the other Porphyrias besides the basic 2 were tested with any amount of frequency at all, I have no doubt they'd be at least referenced in FA. I also struggle though too as I read some of the U-World explanations and think how ridiculous/useless certain factoids are. But at the end of the day they could be in there for a reason :/ but I'm just not willing to spend my time on that. I suppose if you've truly mastered everything else and have 2 weeks to kill, you could just to be safe.

Well, I got a 262 on UWSA1 today, which I am not too thrilled about because it is my understanding that UWSA1 tends to over-predict. Interestingly, the vast majority of my incorrects were extremely careless errors. For example, there was one question where they gave you the pO2 in the different chambers of the heart, and you had to simply identify that there was an ASD (a very easy problem which I solved many, many times in different q banks), but I assumed they were giving chamber pressure (also measured in mm Hg), thus turning it into an unintelligible problem...In another question, it asked for the location of the slowest segment of the cardiac conduction system, and I misread it as asking for the fastest. Another one was a simple biostats arithmetic error that my 8 year-old nephew could solve.

I don't know if I should be glad that I don't have any content knowledge deficiencies or if I should be discouraged that I am continuing to make the most idiotically careless errors.

And in regard to your comment, I honestly feel that my knowledge of FA at this point approaches 99%+. In addition to fully maturing Zanki, which was already extremely comprehensive to begin with, I went through FA page by page and made additional cards of every single detail that I was unfamiliar with (i.e. not covered in Zanki, which surprisingly came out to hundreds of cards), including things that most people never even see, like a 1 word label of an obscure enzyme in a diagram that needs to be searched on Wikipedia (e.g. protein kinase R on page 201).

Indeed, my threshold for deciding what to memorize is extremely low. It's only things like the Kozak consensus sequence being (gcc)gccRccAUGG (from UW) that I really hesitate on. However, when it comes to FA, I am confident I will be able to tell you with extreme accuracy what % of my exam could be answered with FA.

I can't wait to read your write-up after you take it. As one of the few people who truly knows FA, I'm anxious to hear what you thought the breakdown is for material.

It sucks that the test taking skills/careless errors are boxing you in right now. I feel like if you had perfect skills you'd easily be in the high 270s. Not much you can do at this point, but I'm sure you'll still hit at least 260+

 

[pbrocks15]

Let’s not forget that UWorld knows it is teaching thousands of students medicine. The NBME, AMA, etc. all know that the process of studying for and preparing for STEP is in itself teaching medicine.

I keep this in mind when encountering random factoids as you guys have referenced (UWorld etc.).

ie. those random factoids aren't so random?

 

[Blunt Dissection]

Just finished nbme 18 myself today. It's frustrating to do these and not see your score go up.

nbme 13 - 209
nbme 15 - 236
nbme 16 - 223
nbme 17 - 230
nbme 18 - 230

Does this mean I'll probably not even break 230 on the real thing

 

[The.Supinator]

Just finished nbme 18 myself today. It's frustrating to do these and not see your score go up.

nbme 13 - 209
nbme 15 - 236
nbme 16 - 223
nbme 17 - 230
nbme 18 - 230

Does this mean I'll probably not even break 230 on the real thing

is there a consistent weakness that you have??? your best bet is to work on nothing but weak areas

 

[pbrocks15]

Just finished nbme 18 myself today. It's frustrating to do these and not see your score go up.

nbme 13 - 209
nbme 15 - 236
nbme 16 - 223
nbme 17 - 230
nbme 18 - 230

Does this mean I'll probably not even break 230 on the real thing

also second what @The.Supinator said and when is your exam?

 

[mikil100]

I focused on UWorld and made Anki cards for everything I didn’t already know. I used Zanki (and kept up with all reviews from day one), so I didn’t feel the need to review FA, Pathoma, or sketchy again.

Was there a point that you stopped doing Zanki before step?

I stopped with not much time left before step because I thought my time was better spent reviewing weak areas rather than focus on 900+ Zanki cards.. my deck is like 95% mature at least. Hopefully this decision doesn't hurt me.

 

[pbrocks15]

Was there a point that you stopped doing Zanki before step?

I stopped with not much time left before step because I thought my time was better spent reviewing weak areas rather than focus on 900+ Zanki cards.. my deck is like 95% mature at least. Hopefully this decision doesn't hurt me.

Didn't you already take your exam or am I thinking of someone else?

PS. How long do you dedicate to your cards per day/ do you also read FA at all along during the day?

 

[Blunt Dissection]

is there a consistent weakness that you have??? your best bet is to work on nothing but weak areas

also second what @The.Supinator said and when is your exam?

5 days from now. Looking at my nbme breakdowns, the only real section where I’m consistently bad is stats. Asides from that, it’s probably cell bio/biochem/genetics - I can never figure out what exactly they’re asking for if they ask me for some DNA related mechanism or if I get some TCA cycle question. I have those scheduled tomorrow and then nbme 19 on Tuesday

 

[Foot Fetish]

Yeah, I am realizing now that UWorld actually contains a staggering amount of detail. I am starting to wonder if all those people who claim they had topics on their tests that "weren't in UFAP" actually just didn't read UWorld carefully enough. Seriously, adenine phosphoribosyltransferase deficiency? I bet if you ask the average person who finished UW what that is, they wouldn't know or would think it wasn't ever mentioned, but in reality it's right there in the answer explanations for a Lesch-Nyhan question, plain as day. I think what people actually mean when they say that something "wasn't in UW" is that it wasn't featured as a primary learning objective of one of the ~2500 questions.

This is really creating a conundrum for me in terms of my remaining study time. Part of me wants to keep doing this slow, methodical second pass, but as any reasonable person would be, I am also filled with doubt that I may in fact just be wasting my time when in reality the test will just be a giant high-yield buzzword fest provided you learned all the main UW objectives + FA-level detail.

 

[pbrocks15]

Yeah, I am realizing now that UWorld actually contains a staggering amount of detail. I am starting to wonder if all those people who claim they had topics on their tests that "weren't in UFAP" actually just didn't read UWorld carefully enough. Seriously, adenine phosphoribosyltransferase deficiency? I bet if you ask the average person who finished UW what that is, they wouldn't know or would think it wasn't ever mentioned, but in reality it's right there in the answer explanations for a Lesch-Nyhan question, plain as day. I think what people actually mean when they say that something "wasn't in UW" is that it wasn't featured as a primary learning objective of one of the ~2500 questions.

This is really creating a conundrum for me in terms of my remaining study time. Part of me wants to keep doing this slow, methodical second pass, but as any reasonable person would be, I am also filled with doubt that I may in fact just be wasting my time when in reality the test will just be a giant high-yield buzzword fest provided you learned all the main UW objectives + FA-level detail.

Same dilemma here, you're not alone.

 

[Elessar]

Was there a point that you stopped doing Zanki before step?

I stopped with not much time left before step because I thought my time was better spent reviewing weak areas rather than focus on 900+ Zanki cards.. my deck is like 95% mature at least. Hopefully this decision doesn't hurt me.

I kept up with all of the reviews until my test day, never skipped a day. I just figured if it’s gotten me this far, why stop now? My review count was only ~600/day by the end though, I might have changed my strategy if I was in the 900’s

 

[Elessar]

Ah, that explains it. I wish I kept up with Zanki. I've matured almost all of it. Not sure if its worth maybe picking a deck a day and doing it, maybe just the pathology decks? Been struggling with this because Zanki was a huge part of my study routine for my school exams and that always allowed me to perform well. Any thoughts?

I think the power of Anki comes from doing it every day - consistently - for long term retention. Probably not worth trying to pick it back up so close to your test date, instead use it to make cards for everything you come across in qbanks that you don’t know.

 

[theboatman]

Yeah, I am realizing now that UWorld actually contains a staggering amount of detail. I am starting to wonder if all those people who claim they had topics on their tests that "weren't in UFAP" actually just didn't read UWorld carefully enough. Seriously, adenine phosphoribosyltransferase deficiency? I bet if you ask the average person who finished UW what that is, they wouldn't know or would think it wasn't ever mentioned, but in reality it's right there in the answer explanations for a Lesch-Nyhan question, plain as day. I think what people actually mean when they say that something "wasn't in UW" is that it wasn't featured as a primary learning objective of one of the ~2500 questions.

This is really creating a conundrum for me in terms of my remaining study time. Part of me wants to keep doing this slow, methodical second pass, but as any reasonable person would be, I am also filled with doubt that I may in fact just be wasting my time when in reality the test will just be a giant high-yield buzzword fest provided you learned all the main UW objectives + FA-level detail.

I have to chime in and share my experience with this. I took the test about 4 weeks ago and scored a 259 (posted my experience a few pages back).

I have a crazy ability to remember peculiar details (UWorld) over short periods of time (weeks to months). I also have a really good memory when it comes to recalling questions and all answer choices on a test for questions I was not sure on.

On my test, I instantly could recognize a true "WTF" question that had not ever shown up in any UFAP area, even as a minute detail in UWorld. I verified these questions at home after the test and could not find the answers anywhere. For these kinds of questions, you just have to remember we all prepare with the same resources so if it wasn't in UFAP odds are most others are missing it so it truly won't affect your score much by missing the question.

Secondly, I want to discuss this whole "memorize every word of first aid" thing. While I was taking my exam, I had this overwhelming feeling of "I could have studied another month and it would have been a complete waste of time". I can count on one hand the number of difficult WTF questions that were truly random factoids that came up once in school or were a single line in first aid. To be honest, I only had 80-90% of first aid memorized, and even that was a bit overboard.

If you prepared well, which most people on here have exceeded, you will get the 4 out of 5 easy questions correct if you trust your gut and don't second guess, which I would estimate gets you to the low 240s. The remaining 1 out of 5 questions I feel like is the most controversial on this site. I strongly believe these questions cannot be adequately prepared for by studying more, memorizing more lines in first aid, or adding additional resources to your study plan. These 250+ defining questions are purely testing your ability to interpret information and think critically.

These 1 out of 5 questions are all the questions I went home and wrote down and spent days googling and looking through UFAP to see what made them so difficult. An overwhelming majority of these questions were pure thinking questions: take a very basic process and test whether you really understand it. The remaining few were not found in UFAP, and for these I wouldn't sweat them at all. There really aren't many on the test.

What I'm trying to say is, I think people on here make a big flaw by thinking that more studying/memorizing more small facts is what will push them into the 250+ range. While this may work for a minority of people, I want to assure those people with a methodical, logical, and well-developed thinking style that that alone combined with adequate preparation at home will be enough to succeed on test day.

I did not pass through first aid 3 times trying to memorize. Each pass of first aid was to test my understanding. If I understood everything on the page, I moved on. I promise this was enough for me on test day.

 

[Rahas]

I have to chime in and share my experience with this. I took the test about 4 weeks ago and scored a 259 (posted my experience a few pages back).

I have a crazy ability to remember peculiar details (UWorld) over short periods of time (weeks to months). I also have a really good memory when it comes to recalling questions and all answer choices on a test for questions I was not sure on.

On my test, I instantly could recognize a true "WTF" question that had not ever shown up in any UFAP area, even as a minute detail in UWorld. I verified these questions at home after the test and could not find the answers anywhere. For these kinds of questions, you just have to remember we all prepare with the same resources so if it wasn't in UFAP odds are most others are missing it so it truly won't affect your score much by missing the question.

Secondly, I want to discuss this whole "memorize every word of first aid" thing. While I was taking my exam, I had this overwhelming feeling of "I could have studied another month and it would have been a complete waste of time". I can count on one hand the number of difficult WTF questions that were truly random factoids that came up once in school or were a single line in first aid. To be honest, I only had 80-90% of first aid memorized, and even that was a bit overboard.

If you prepared well, which most people on here have exceeded, you will get the 4 out of 5 easy questions correct if you trust your gut and don't second guess, which I would estimate gets you to the low 240s. The remaining 1 out of 5 questions I feel like is the most controversial on this site. I strongly believe these questions cannot be adequately prepared for by studying more, memorizing more lines in first aid, or adding additional resources to your study plan. These 250+ defining questions are purely testing your ability to interpret information and think critically.

These 1 out of 5 questions are all the questions I went home and wrote down and spent days googling and looking through UFAP to see what made them so difficult. An overwhelming majority of these questions were pure thinking questions: take a very basic process and test whether you really understand it. The remaining few were not found in UFAP, and for these I wouldn't sweat them at all. There really aren't many on the test.

What I'm trying to say is, I think people on here make a big flaw by thinking that more studying/memorizing more small facts is what will push them into the 250+ range. While this may work for a minority of people, I want to assure those people with a methodical, logical, and well-developed thinking style that that alone combined with adequate preparation at home will be enough to succeed on test day.

I did not pass through first aid 3 times trying to memorize. Each pass of first aid was to test my understanding. If I understood everything on the page, I moved on. I promise this was enough for me on test day.

100% agreed with this. While I haven't taken the exam yet, this is the exact feeling I've gotten speaking with high scorers and my own personal experience with NBMEs & UWSA2. It makes no sense to me that the exam will throw in questions they believe the vast majority of test takers have never and will never come across as medical students, because what does that tell them? That medical students dont know stuff they're not supposed to know? And if someone gets it right, he/she got lucky either in the exam, or during his time as a student to have come across it. I'm sure they're not out to pick lucky people.

I'm fairly certain these difficult questions somehow test your ability to think methodically & logically, and your ability to recognize patterns etc. I think a lot of these questions are probably solvable if you have excellent basics and can work through the clues in the question stem.

@FootFetish If I were in your place I'd never, ever try to overwhelm myself with so much new information this close to the exam. Regardless of how well you know or think you know FA or whatever you've already studied, I'd go over that. These minutiae at best might yield you a couple of questions, but the price might be a larger number missed due to forgetting stuff you should know cold. Questions have a weird way of making you fumble when you're only 90% sure.

 

[bonemann]

I had similar experiences to the last two posters.
I found my exam to be frankly underwhelming but also disconcerting given how many absolute gimmes i saw.
It felt like 70% of all the questions were stuff that everybody knew, and while I felt like I knew most of them, im worried about the unforgiving curve to come.
The hard questions I encountered where mostly asking about an obvious disease process but wanting either some factoid that the typical student doesn't learn to link to the disease, or they wanted you to explain the mechanism of disease by linking it to another physiologic concept that you don't usually consider as linked. For these 'hard' questions I felt like it took mostly test-taking skills + critical thinking to figure out.
I did UWorld once, pathoma maybe 1.5x, sketchy micro but not pharm, most of BB and a small amount of Zanki.
I didn't read First Aid and given that I already knew the gimmes, giving it a full read wouldn't have significantly affected my score.
(the most challenging section for me was actually the behavioral stuff, which showed up more often than anyone would have thought - FA wouldn't have really helped for this either - the scenarios in FA are all too obvious)

Overall I felt that the exam was definitely fair if unfortunately too 'easy' in that there were too much gimmes a la old NMBEs.
I also recognized at least 2 questions and a couple of images.

My practice scores towards the end were around the low 250s, 90% on Free120

I don't think I would have done anything differently looking back. The exam felt like a combo of NBME and UWorld, with a couple of super vague/difficult questions per block. I flagged about 9-10 per block and the break times were more than plenty.

I don't regret not doing SketchyPharm and not reading FA.

 

[The.Supinator]

5 days from now. Looking at my nbme breakdowns, the only real section where I’m consistently bad is stats. Asides from that, it’s probably cell bio/biochem/genetics - I can never figure out what exactly they’re asking for if they ask me for some DNA related mechanism or if I get some TCA cycle question. I have those scheduled tomorrow and then nbme 19 on Tuesday

I would focus on biostat the most, it will give you the best return on investment of time at this point

 

[intubesteak]

Yeah, I am realizing now that UWorld actually contains a staggering amount of detail. I am starting to wonder if all those people who claim they had topics on their tests that "weren't in UFAP" actually just didn't read UWorld carefully enough. Seriously, adenine phosphoribosyltransferase deficiency? I bet if you ask the average person who finished UW what that is, they wouldn't know or would think it wasn't ever mentioned, but in reality it's right there in the answer explanations for a Lesch-Nyhan question, plain as day. I think what people actually mean when they say that something "wasn't in UW" is that it wasn't featured as a primary learning objective of one of the ~2500 questions.

This is really creating a conundrum for me in terms of my remaining study time. Part of me wants to keep doing this slow, methodical second pass, but as any reasonable person would be, I am also filled with doubt that I may in fact just be wasting my time when in reality the test will just be a giant high-yield buzzword fest provided you learned all the main UW objectives + FA-level detail.

My opinion is that the real test is more about concepts and critical thinking than discrete facts. I think us med students confuse these two things all the time though (example: the ins and outs of PTU vs Methimazole--this seemed minute when studying but it has come up three times with real patients in my first clerkship, so obviously its important in the real world). With Uworld my goal was to make sure I knew why each answer was correct or incorrect. I stopped stressing about the details they throw in there, which I think are meant to provide more context so you can understand the answer better. That line of thinking got me into the 260s but given your goal is a bit higher you may want to take this with a grain of salt.

 

[intubesteak]

I had similar experiences to the last two posters.
I found my exam to be frankly underwhelming but also disconcerting given how many absolute gimmes i saw.
It felt like 70% of all the questions were stuff that everybody knew, and while I felt like I knew most of them, im worried about the unforgiving curve to come.
The hard questions I encountered where mostly asking about an obvious disease process but wanting either some factoid that the typical student doesn't learn to link to the disease, or they wanted you to explain the mechanism of disease by linking it to another physiologic concept that you don't usually consider as linked. For these 'hard' questions I felt like it took mostly test-taking skills + critical thinking to figure out.
I did UWorld once, pathoma maybe 1.5x, sketchy micro but not pharm, most of BB and a small amount of Zanki.
I didn't read First Aid and given that I already knew the gimmes, giving it a full read wouldn't have significantly affected my score.
(the most challenging section for me was actually the behavioral stuff, which showed up more often than anyone would have thought - FA wouldn't have really helped for this either - the scenarios in FA are all too obvious)

Overall I felt that the exam was definitely fair if unfortunately too 'easy' in that there were too much gimmes a la old NMBEs.
I also recognized at least 2 questions and a couple of images.

My practice scores towards the end were around the low 250s, 90% on Free120

I don't think I would have done anything differently looking back. The exam felt like a combo of NBME and UWorld, with a couple of super vague/difficult questions per block. I flagged about 9-10 per block and the break times were more than plenty.

I don't regret not doing SketchyPharm and not reading FA.

I had a very similar experience. Test felt too easy...turns out I did well and you probably will too. Sketchy and FA are overrated, didn't use them either.

 

[intubesteak]

How were your NBMEs and how much did you end up with?


Sent from my iPhone using Tapatalk

NBME15 (baseline 8ish weeks out)--237
Free 120 (3 weeks out)--88%
NBME 19 (one week out)--246

Real deal--263

 

[pbrocks15]

I had a very similar experience. Test felt too easy...turns out I did well and you probably will too. Sketchy and FA are overrated, didn't use them either.

What was your dedicated period like then?just UWorld?

 

[intubesteak]

What was your dedicated period like then?just UWorld?

Got my score back the other day and home from vacation now so here's my write up...

NBME15 (baseline 8ish weeks out)--237
Free 120 (3 weeks out)--88%
NBME 19 (one week out)--246

Real deal--263

I was honestly shocked to see my score. My goal was a 250 and I never dreamed of breaking into the 260s! I've already discussed my test day experience but to recap--felt just like an NBME, very similar to 19. I must have been very lucky in retrospect because there were no major surprises and I felt like I could reason through all the questions.

Resources used (in order of importance)

Uworld--nothing groundbreaking to say here. Did a first pass before dedicated which was helpful for me (69% first pass). About 1/2 was alongside of my organ system blocks, the other half I did random mode in the months leading up to dedicated. I did not take notes or anything the first pass. Second pass during dedicated I did 60-80 questions per day, mostly random tutor mode. Second pass was 84%. I took some notes which I compiled in Excel...but nothing too crazy because I forced myself to write them in my own words without looking at Uworld. This helped solidify things. I did not do any flashcards for Uworld. I did some of my incorrects during the week of my test, especially the hated topics of biochem and neuro.

Firecracker--I could do a really long, in depth discussion of this resource but I will keep it short here and just say that I feel this is hands down the best review resource out there. It is absolutely the most comprehensive without being too detailed. It is NOT simply first aid in flashcard format (I thought this until I actually used FA a little bit lol). There are really good explanations of topics not found anywhere else that helps you not have to memorize as much (understanding mechanism and the "why" behind stuff). I used it extensively alongside classes, and I did a lot of flashcards during dedicated. I also read through topics and used it like a review book which was helpful, but forced recall is undoubtedly the way to go if you can make the time for it. 1000% would do firecracker again, worth every penny.

Goljan--discovered this gem about 2/3 through my organ system curriculum. The beauty of this book is that Goljan explains the mechanism behind just about everything--there are so soooo many "ah hah" moments where you finally get to fully understand something you have tried to rote memorize in the past. For me, I think the key to my score was memorizing as little as possible, and trying to get as much information/mechanism as I could to stick long-term. Goljan was absolutely key for this!! (but doing questions is better/just as important...). I read through all the organ system chapters in Goljan 2-3x during dedicated, and the basic science stuff 1.5x. I was really kicking myself for not having started the basic science stuff earlier because there is some GOLD in there...overall this was a great resource for me and the most enjoyable to read/use.

All other resources were used sporadically/minimally:

Pathoma: watched on the treadmill, alongside classes and during dedicated. For dedicated I only watched chapters that I was weak on (like breast cancers, bone tumors, blood cancers, glomerulopathies, etc). I also did the foundational (first three chapters stuff) more in depth because I was very weak on this stuff and it kept coming up in NBMEs.

Rx Qbank: Did probably 80-90% alongside my classes. Honestly a very solid Qbank that helps drill in the most important concepts and facts. I did a few blocks in some of my weaker areas during dedicated (a good bit of neuro).

First Aid: Did not like the formatting/content of this book at all...Just was not working for me. I think I need more than just bullet points and phrases to engage my brain...That being said, I did one pass through the basic science section in the 3 days before my test, and having done a lot of questions at that point I was able to make more connections and engage my brain a little better. But it really freaked me out when I would come across random facts and stuff that I felt like I didn't know or had not seen before (FA has plenty of LOW YIELD crap that was never in Uworld, NBME, other resoruces, etc...). Moral of the story is YOU DO NOT HAVE TO USE THIS BOOK IF YOU DONT LIKE IT!!!

Robbins Qbank and text: Used extensively alongside classes. Time would have been better spend with GOLJAN (although the questions were probably pretty helpful, but a lot are on random diseases and crap that never comes up again).


Overall, the most important things for me were understanding mechanisms behind stuff (without going too crazy here) so that I could memorize as little as possible. Most of this was done alongside my classes and just refreshed in dedicated. I also had a really, really positive attitude on test day and totally pumped myself up! (test day soundtrack--We Are The Champions, We Will Rock you, A Country Boy Can Survive, etc...)

During classes I always did reasonably well but was nowhere near the top (except on one or two blocks like micro). I usually got low A's on test or high Bs. I actually completely stopped listening to lectures during my last semester and would only read through the powerpoints maybe twice or three times...AFTER having read the textbooks. I spent a ton of time during classes reading books, doing flashcards (firecracker), and doing practice questions. I realized that doing the lecture deal took the longest and was the least helpful for me...so I prioritized accordingly.

My goal in med school has always been to just learn stuff well, and the fields I'm interested in do not require a high step score. This allowed me to break away from the UFAPs mantra and lectures, which was a major risk in my mind but absolutely paid off. Good luck to everyone studying for this beast!!!!

Sorry for the long quote! TLDR: Uworld, Firecracker, Goljan

 

[mikil100]

Didn't you already take your exam or am I thinking of someone else?

PS. How long do you dedicate to your cards per day/ do you also read FA at all along during the day?

I didn't take mine yet, soon though!

My average speed was about 550-600cards/H, sometimes I could push that to 700 but then you really start losing out on details and can't really read diagrams etc. And I did exactly 1 read through of FA (not counting reading it during the school year). Zanki missed a few things but you certainly could skip out on reading FA, especially if you're doing something comprehensive like B&B+ Zanki.

 

[MissKitty2868]

To anyone that has already taken Step, how useful was the Rapid Review section at the back of First Aid?
Did anyone find it helpful for the real deal?

I reviewed it the night before my beast, and there were at least ten questions that came from it that I actually didn’t know until I read it. I’d say that is a helpful thing to review the night before. It also kinda tests your preparation to use it like flash cards to see if you know it or not.

 

[Blunt Dissection]

I would focus on biostat the most, it will give you the best return on investment of time at this point

Yeah, I agree. I spent some time today looking at my spread across all the exams and I think just spending an entire day or so on cranking out stats would probably be the best thing to do with the 5 days I have left. I'm basically trying to scrape as many points as I can at this point. I got the UWorld Biostats review and I'm planning on watching the Boards & Beyond videos on this stuff. This is the rest of my spread though and I could probably spend some time on genetics* as well by the looks of it.

 

[0hour]

Hey everyone recent lurker here! Got my step score and got some down time to reflect. Wanted to share my experience with others in case it may help. I'll use ranges for my score for the sake of anonymity.



Dedicated=4.5 weeks but moved a few days back->5 weeks

CBSE (2 months out)~195

NBME 15 (3.5 weeks out)=219

NBME 17 (2.5 weeks out)=225

UWS2 (1.5 week out)=254

Decided to move my test back 4 days at this point since I was so fatigued and was worried I wouldn’t have energy during the test itself.

NBME 18 (5 days out)=230

Free 120 (2 days before)=88%




Step 1 Score~255!



The actual test felt like a bunch of UWorld blocks. I knew if I could mark 4-5x per block I felt I could break 260 based on UWS2. I ended up marking 10-12 on average, and marked if I wasn’t more than 95% certain on the answer. I slept 3 hours the night before (my body was in fight or flight mode and I couldn’t fall asleep even when I was on trajectory to get 8 hours) so blocks 3-5 felt like a blur, as if I was on cruise control. I felt I didn’t have too many out there “I have no idea” questions. Even if I never saw the topic before, which there were a decent amount, I felt I could reason my way through and use property of exclusion. Leaving the test I didn’t feel like I got a grand slam but I didn’t feel bad either. I knew I missed about 6 for sure as soon as I left the test center. 3 of those were ones where I second guessed myself and should have stuck with my first instinct. Of the remaining marked I remembered about 15 marked questions that I looked up same day, which of those I got 11 right and 4 wrong. Assuming that trend of correct:incorrect for all other marked questions with some slipped questions/dumb mistakes, I’d say I probably missed ~4-6 per block on average.



So some info to put the scores in perspective:

Pre-dedicated: Did Uworld 1x (55% first pass) and .6x Pathoma (did not due first three chapters until middle of dedicated and missed some other sections). Occasional B&B to supplement with classes but I mainly only used it for pulm, renal and cardio. No FA reading. Minimal sketchy micro and no sketchy pharm
Went to school lectures though and made sure to have a solid base from classes to work with.


Dedicated: (UFAPS) Uworld 2nd pass (87%) and then incorrects, 2x read FA, 1x pathoma, 1x sketchy micro, .8x sketchy pharm
Finished my first pass of first aid 1.5 week before the test and then did a quick second pass.
At most during my 2nd Uworld pass I’d remember 1-3 questions per block so I felt my 2nd pass wasn’t too inflated by remembering the question, but it was prob inflated from being accustomed to Uworld type questions in general.



Preparation and Dedicated:
So my approach was to focus on classes and then a few months before dedicated starting incorporating step studying while keeping up and building my foundation with classes. I wasn’t as good with time management during the year as I should have been, but my must do goal was finish 1 pass of Uworld before dedicated with annotations in first aid. I aimed to learn from UWorld what class didn’t cover and have all that info with first aid in one place.

At the start of dedicated I felt I had a decent grasp of a lot of Step 1 knowledge, but it wasn’t organized in my head. There was just a bunch of facts or concepts floating around and I could not connect it all. The read through of First Aid with annotations was the key for me to put it all together, so then I was able to compartmentalize the knowledge and pull it out better. At that point I felt I had the “narrative” of Step 1 info so to say, which for me that happened a few days before I took UWS2.

Don’t know why I scored low on NBME 18 but I feel all the NBME’s just threw me off and I can’t describe why. I wasn’t rattled by my scores because I knew all the info was there and I was confident in my knowledge. I just had to see the material at least once and I’d be good, which UW2 and the free 120 confirmed for me. I’ve seen a few other posts where people greatly outperform their NBME’s on UWS2 and the real deal. I’m sure it’s a good predictor for most people, and I’m sure it goes the other way too, but I hope my post shows that it is not final and maybe a few people can be encouraged knowing they can do much better than their predicted.


Final thoughts:
UWS2 was the closest predictor for me.
I highly recommend the 2 passes of Uworld. I feel the real deal is most similar to Uworld blocks, so why not spend most of your prep time with questions that will be closest to the actual test?

If I could go back and do something different, I would have before dedicated: done a pass of sketchy pharm+micro, all of pathoma with annotations into first aid, and read off first aid with each block or do Rx as an alternate Q bank to go through first aid if I couldn’t read it. With this I would have been a lot stronger at the start of dedicated, and wouldn't have been so close to the test date for me to have my "aha!" moment. I honestly planned for the first 2 but just did not execute well in the pre-dedicated time.

Boards and Beyond to me was a good auxiliary resource to supplement topics as needed, but not a must to go through.

Also on switching test dates: I pushed my test back a few days as I was getting fatigued and wasn’t sure I’d be 100% during the test. I feel it worked for me even though I slept horribly the night before. If you think you need more rest or just need a few more days to iron out a certain subject, go with your gut.

 

[The.Supinator]

Yeah, I agree. I spent some time today looking at my spread across all the exams and I think just spending an entire day or so on cranking out stats would probably be the best thing to do with the 5 days I have left. I'm basically trying to scrape as many points as I can at this point. I got the UWorld Biostats review and I'm planning on watching the Boards & Beyond videos on this stuff. This is the rest of my spread though and I could probably spend some time on stats as well by the looks of it.
View attachment 234651

your doing well in other subjects, its that rough NBME curve that's makes it seem like you have other weaknesses, but ya hit up biostat, do the uworld biostat form, the extra one, that is super helpful.

 

[sharkbyte]

NBME 17: 244!!!!!

Overall, thought it was a fair exam. Definitely some curveballs. As expected I am weak in anatomy (especially neuro) and various aspects of embryology. The ethics questions on this one were pretty wonky too. They make it really hard to determine whether some responses by a doctor are just like, barely acceptable in terms of not being condescending to a patient. I'm 12 days out so I'm pretty happy with this. Still have 18, 19, and UWSA2 left. Well and 16 but I don't really feel like taking it lol.

Are 18 and 19 significantly harder than 17? I've heard from one person that they felt 19 was relatively straightforward, but maybe it depends on each person's proficiencies. I've heard 18 is a hard test.

 

[Lannister]

The ethics questions on this one were pretty wonky too.

Yes!!! Was NBME 17 the one where there was a question with a patient who asks the doctor if it's bad news, and the answer was "yes, it is."??

 

[Blunt Dissection]

Yes!!! Was NBME 17 the one where there was a question with a patient who asks the doctor if it's bad news, and the answer was "yes, it is."??

That question made me lol during my review because I kept getting dinged all year in our doctoring class for not being empathetic enough and when I go and choose the empathetic answer, nbme tells me "nah, you should just get to the point"

 

[sharkbyte]

Yes!!! Was NBME 17 the one where there was a question with a patient who asks the doctor if it's bad news, and the answer was "yes, it is."??

Yes

I got that one wrong. I put "Tell me how you're feeling." I guess I can sort of understand, since in that question it looked like the patient was able to tell from the physician's expression that it was bad news, so if you're the doctor it might not be beneficial to beat around the bush? Either way, that one annoyed me (another one that kind of pissed me off was the overweight kid asking about whether his weight was inherited or not, I was between two answers for like, forever on that one).

 

[Lannister]

That question made me lol during my review because I kept getting dinged all year in our doctoring class for not being empathetic enough and when I go and choose the empathetic answer, nbme tells me "nah, you should just get to the point"

Hahaha yeah I always put the "tell me about your feelings" option and it's almost always correct. Except that time.

 

[sharkbyte]

Also, do any of you guys know the gradations between each 10-point difference on the NBME raw scores? Like, is the difference between a 540 and a 550 like, 2-3 questions?

 

[frozensphagetti]

Would anyone be receiving scores this week or are we all waiting on July 11th?

 

[Lannister]

Would anyone be receiving scores this week or are we all waiting on July 11th?

Interested to know this as well, the announcement mentioned something about some testing centers being delayed more than others. So I wonder if some people will get their scores and others won't.

 

[Rahas]

That question made me lol during my review because I kept getting dinged all year in our doctoring class for not being empathetic enough and when I go and choose the empathetic answer, nbme tells me "nah, you should just get to the point"

SPIKES protocol my friends, if he's asking what is it, you're already at the I stage. Next is K. Tell him!

 

[Blunt Dissection]

SPIKES protocol my friends, if he's asking what is it, you're already at the I stage. Next is K. Tell him!

I just googled that and I'm mindblown that never has this been mentioned in my 2 years in school! And it's not in first aid!

 

[Rahas]

I just googled that and I'm mindblown that never has this been mentioned in my 2 years in school! And it's not in first aid!

Its in UWorld, theres a full table on it. I'm going to admit I memorized it point for point. Though you really dont need to, just knowing the basic steps is enough to answer any of these bad news delivery questions. I've actually never heard SPIKES being mentioned here though, maybe people haven't realized its usefulness?

 

[jimmyd1]

I know that people say the curve for NBME 19 is harsher, but how does it compare question difficulty wise to NBME 17?

 

[mikil100]

I know that people say the curve for NBME 19 is harsher, but how does it compare question difficulty wise to NBME 17?

Moderately easier, I would say. My experience in NBME difficulty (from hardest to easiest would be 18>13>17>19. Of course the curve on 19 is atrocious because of that.

 

[sharkbyte]

Moderately easier, I would say. My experience in NBME difficulty (from hardest to easiest would be 18>13>17>19. Of course the curve on 19 is atrocious because of that.

Not that it's super important or even beneficial to worry so much about curves and difficulty levels, but just to satisfy my curiosity, what was your overall take on 18? What types of things made it hard? Did they ask a lot of questions out of nowhere, or were they just harder than some of the really quick/easy questions on other NBMEs and instead more like UWorld?

 

[orangetea]

Not that it's super important or even beneficial to worry so much about curves and difficulty levels, but just to satisfy my curiosity, what was your overall take on 18? What types of things made it hard? Did they ask a lot of questions out of nowhere, or were they just harder than some of the really quick/easy questions on other NBMEs and instead more like UWorld?

I personally felt like the questions were on concepts that you would probably already know judging by your high scores.. but they just asked them in such a weird way that it was hard to figure out "what" they were asking. But I felt like the curve adjusts for that ... I personally gave up past the first block mentally and I think my score reflected that. haha

 

[orangetea]

Also, for those that took the exam, how relevant were ECG and heart sounds. I obviously am going to review them but was just wondering how "how yield" those were

 

[Integral]

Also, for those that took the exam, how relevant were ECG and heart sounds. I obviously am going to review them but was just wondering how "how yield" those were

Definitely high yield for STEP and for practice.

 

[strugglebus9118]

Would anyone be receiving scores this week or are we all waiting on July 11th?

I’d like to know too

 

[mikil100]

Not that it's super important or even beneficial to worry so much about curves and difficulty levels, but just to satisfy my curiosity, what was your overall take on 18? What types of things made it hard? Did they ask a lot of questions out of nowhere, or were they just harder than some of the really quick/easy questions on other NBMEs and instead more like UWorld?

It was a bit ago but I think it had a fair mix of basic science/interepret the meaning of x type questions that you couldn't necessarily study for, also harder ethics questions. In the end it was fine, but definitely less first order "name the dx/what is a likely complication" questions that they like to ask that could probably be answered straight from Pathoma.

 

[The Knife & Gun Club]

Curious what you mean when you say harder ethics questions?

Do you just mean questions where the answer isn't "ask the patient how they feel" lol?

Personally I always seem to find the ethics questions either impossible or slam dunks.

 

[Lannister]

Just finished NBME 19. I kind of misinterpreted the reason that everyone scores so low on 19, I thought it was because the test was so hard. Turns out it's just an easier NBME and therefore has a tough curve.
So now that I'm done with all my practice tests, my final scores are:
NBME 13: 234
CBSE: 248
UWSA1: 258
UWSA2: 256
NBME 15: 263
NBME 16: 261
NBME 17: 257
NBME 18: 255
NBME 19: 255

I'm pretty happy with that. Just a little confused though because it seems like on SDN everyone's NBME 19 score seems to way under-predict, but when I look at the self assessment/step 1 correlation thing on Reddit, a 255 on NBME 19 pretty much correlates to a 255 on the real thing. I guess 19 gets more predictive with higher scores?

 

[intubesteak]

Just finished NBME 19. I kind of misinterpreted the reason that everyone scores so low on 19, I thought it was because the test was so hard. Turns out it's just an easier NBME and therefore has a tough curve.
So now that I'm done with all my practice tests, my final scores are:
NBME 13: 234
CBSE: 248
UWSA1: 258
UWSA2: 256
NBME 15: 263
NBME 16: 261
NBME 17: 257
NBME 18: 255
NBME 19: 255

I'm pretty happy with that. Just a little confused though because it seems like on SDN everyone's NBME 19 score seems to way under-predict, but when I look at the self assessment/step 1 correlation thing on Reddit, a 255 on NBME 19 pretty much correlates to a 255 on the real thing. I guess 19 gets more predictive with higher scores?

I think 19 under-predicts in general (17 points for me). Not sure about the reddit correlations, but my scores were not in line with them. A few dumb mistakes will drop your score quite a bit on 19, whereas the real deal probably has harder questions and a more forgiving curve. Your scores are looking great, time to take the real deal!