Step 1 score 263 - AMA

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Aug 30, 2019
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These threads helped me and so i thought I would share my experience, contribute my data, and try to answer any questions.

I'm a 3rd-year at a top/middle tier US med school and went to an ivy league school for undergrad.

UWA1: 256
CBSE paid for by school: 245
NBME 21: 240 (1 month out)
NBME 24: 246 (20 days out)
NBME 23: 244 (15 days out)
NBME 18: 257 (10 days out)
UWA2: 262 (6 days out)
Free 120: 90% (3 days out)
UWorld % correct: 81%
Step 1: 263

- FA (imo not meant to be read cover to cover. I referenced this so many times after doing practice questions and added notes to the margins from all the other resources that it became my bible and by the end could see the page of interest for a given topic. None of the resources are comprehensive enough to get a 250+ and since FA is the most comprehensive, i added the missing info from the other resources to its margins.)
- Pathoma (adding video notes to the book because not everything in videos is in book)
- Sketchy (micro and pharm only)
- UWorld
- Anki (a main, but did not use in traditional fashion. I press 'B" and use the browse function to flip through the cards and flag the HY or difficult ones)

- Boards and Beyond maybe 50% of their content on my weak areas (e.g. lysosomal storage diseases)
- USMLERx for extra questions after I finished UWorld (there are papers showing more UNIQUE questions correlates significantly with increased points on step1)
- BRS physiology (minimally -- only select chapters on kidney/heart/lung phys)
- Basic immunology by Abbas (i didn't use for step studying but used it for my immuno course and it was amazing)

Study Schedule
I started doing UWorld questions around 6 months before I took step 1. I did them by subject to supplement the lecture material and help with the finals. I don't believe in "saving" UWorld questions for dedicated. They are meant to be teaching tool not a testing tool. So while i included my % UWorld correct above, it doesn't really mean anything -- what matters is how well you learn from them. I also didn't refresh my UWorld and start over. I did go through about 50-60% of questions and read the stem and the answer descriptions. You will find the same questions a second time is really easy because you remember the question and don't learn from the question (hence why only # of UNIQUE questions correlate with increases in scores). This is when i would do USMLE Rx questions (I probably didn't even do half. I primarily selected the tougher ones that were guaranteed to teach me something. Did not care if i got them wrong because -- like UWorld -- it is a teaching tool. Use the NBME and UWA as measures of preparedness (especially NBME 18 and UWA2 - don't take them first).

For the month leading up to my test, i made an Excel spreadsheet to keep me on track. I woke up at 6, did a block of UWorld and studied that block by 11 or so. Its important to reference first aid when going through UW explanations and adding any notes in the margins. Then I did a 3.5-hour afternoon block of focused review of a FA chapter along with the corresponding Pathoma and sketchy pharm. When covering micro, I also reviewed sketchy micro. Then i would exercise for an hour, half cardio/half squats to increase testosterone/confidence. Evening block of 3.5-4 hours covered another FA chapter + corresponding resource. During this time, and maybe even during the last 2 months, I started to feel like i knew the majority of the material and made a Word document to write down the nuggets that had escaped me during my first pass of everything or the info that I could never quite lock down. The day before the test I read this document, flipped through FA a bit, and took the evening off.

One big key to doing well on this test is in test taking strategy, which for some reason doesn't get enough discussion on these forums. I can try to answer questions on this if anyone wants.

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Thank you for doing this. In regards to test taking strategy, how did you approach questions? What would you recommend for someone (me, lol) that's not too confident in their test taking skills?

And can you go into more detail on your unorthodox Anki method? How did you make sure you were getting your reps in over time? Or did you just do it prn?
The more questions you do, you get used to the recurring structure of the case. Few sentences of chief complaint, vitals, physical exam, then 1-2 sentences for the question. I start by glancing at the answer choices without reading them, to frame the lens through which i read the question stem. Then i read the last 1-2 sentences to read the question. Then I read every word of the case. After doing many questions, you get a good sense of what vitals and lab values are abnormal wihtout referencing the lab button (time is of essence). Focus on the abnormal.

You will start to see patterns in how they ask about certain diseases. A good resource for learning how the question writers think is to listen to the "Goljan audio lectures". For example, he says if the stem mentions a male athlete they are setting up for a steroid question -- thats how they ask that. Moreover, if the stem mentions a country or region, that is probably important (fungal infections in america, or tropical diseases, vaccination status, etc). Obviously you will see buzzwords, but also important is noticing when they don't mention things that are important to a potential answer choice (e.g. if a patient is in shock but didn't just consume food then the type of shock likely won't be anaphylactic).

IMO anki takes forever and is impossible to balance other resources without giving up social/dating life, research, exercise, etc. I can go through a lot more cards and shuffle back and forth to reinforce the cards i want to immediately and when i want to, i dont have to wait until 4-10 days or whatever. You can study other resources and then come to anki and youll know a lot of the answers and skip over them and highlight the ones that are harder and give preference to those when flipping through. Seeing a card once a day is not helpful for me. Another benefit is to see all the cards in order really fast and see the bigger picture, then going back and going through slower. hope this perspective helps!
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How (if at all) did you use practice questions during M1 / M2 before UWorld? Or was UWorld your first Q-bank?
How (if at all) did you use practice questions during M1 / M2 before UWorld? Or was UWorld your first Q-bank?

Where I go to school, the final exams questions were based on the class powerpoints and the questions they provided (made up by our professors). I mainly used these for my M1 year to study, progressively using more of the above stated resources as the year went on and I got more comfortable managing the work load.

During my M2 year, I started to use Uworld around november because I understood that the material taught in classes was not enough to do well on Step 1. So instead of learning a lot of new information after my curriculum was finished, i supplemented my educations as time allowed to do Uworld questions (+ First Aid chapter + pathoma). I never was able to finish all the subject specific questions after studying the course material before the final. But i think doing a good chunk, in subject-specific blocks, was a great primer for my dedicated study period. I also believe that doing a lot of subject specific questions back to back helps identify nuances in patient presentations, lab values, and physical exam findings that are classic differentiators that are priceless cues on test day to understand what the correct answer is. Sure, when Step 1 comes around, it is helpful to do random blocks of questions to prevent recall bias or whatever. My strategy integrated both styles of using Uworld.

Hope this helps!
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