Took the exam on July 22nd.
Step 1: 255
NBME 4 - 1 month out (first day of dedicated studying): 240
UWSA - 3 weeks out: 264
NBME 6 - 2 weeks out: 260
NBME 7 - 1 week out: 258
Free 133/150/whatever - 4 days out: 93%
UWorld (2nd run through, random timed blocks of 44): 89%
Study regimen
Essentially I feel what helped a lot was studying very diligently for Step 1, as well as studying diligently for my shelf exams during 3rd year. I felt this gave me a good foundation going in to dedicated studying where I wasn't starting from square 1, but more so refreshing and able to focus on weak spots from day 1. NBME4 proved that fact to me, that studying well during the year would really pay off, I didn't believe it until I took this exam before even cracking open a book. Felt good, and started from there.
The sources I used were:
- MTB2: I read this probably 2 times cover to cover, and blew through the cardio section the day before the exam. I liked it. Not as good as First Aid for step 1, but the closest thing I found honestly in regards to a "Bible". I felt confident trusting this resource.
- Online MedEd: I hate to spill the beans on this but I thought this was a phenomenal resource. Where other books (looking at you Step Up to Medicine) simply outline test options and treatment options, MedEd really provides the algorithms and trees you need to know. I felt like I got about 5 questions right on the exam about simple diagnostic decisions simply from here. I paid for the subscription, printed out all the notes, read them along with the videos on 2x speed, and then re read the pages with algorithms in the week leading up once again. I have a warning that some of the notes and videos do have minor errors and some outdated facts strewn about, but the general concepts remain true. I NEVER understood the breast lump/breast imaging algorithm until MedEd, same with thyroid nodule, and solitary pulmonary lesion. Also the endocrine work ups! Bone age, MRI, GnRH.... invaluable. Totally. I feel like once they refine this and really get well noticed it will be the "Pathoma" for Step 2.
- MTB3: I just read this cover to cover once for completeness sake out of neuroticism. Not sure if it helped, but didn't hurt. Just ran out of things to study.
- Anki: I made my own cards as I came across facts and rote memorization pearls in my day to day studying. Started off every morning with this to warm up.
- UWorld: Of course. Completed a run through during 3rd year studying for shelf exams. Then reset it my first day of dedicated studying. I only did random timed full blocks 2 a day, 3 a day when test was getting closer, then finished my incorrects a few days before. Was hitting ~85-92%... with a highest of 100% and a lowest of 66% (like one week out - lmao - blamed it on being distracted). I would rewrite learning objectives and anything I wasn't totally confident in, and reviewed this stack of notes (printed out about 25 pages front and back) twice in the week before. Had charts in it as well.
- UWorld stats: just blew through it once
- Kaplan QBank: I did this during the year just whenever I felt like it, and also to study for shelf exams. Never revisited it again once I was done, but I kept a word document like for UWorld of learning objectives and facts I didn't know. About 20 pages front and back. Read it once the week before then tossed it out
- Refreshed some basic concepts in First Aid for Step 1, and a few Pathoma pages here and there
- UpToDate: Like Phloston recommended, I didn't go too hardcore on this, but would look up some stuff, print it out, and review it time to time, had about 10 pages front and back.
- And honestly other than that, any time I came across a distractor I didn't know, or a word I didn't know, or anything, I would just wikipedia it.
Sources I did NOT use:
- Step 2 Secrets: I thought it was awful. Type is way too small. Doesn't flow at all. It hurt my head reading it and it had no flow of concepts to it or anything. Just "If A --> B" ... "In disease X --> This happens". Read about 100 pages of it and stopped.
- Step up to Step 2 CK: Joke of a book. Bought it, opened it up, and put it in my closet.
- Step up to Medicine: Carried it with me as like a text book to look things up but I would highly discourage from reading this cover to cover. Too dense.
I felt pretty confident going in to the exam. Nothing like Step 1. I had trusted my preparation, and wasn't too worried about it. Had heard it was going to be long and I was ready.
Actual exam experience:
Was a grab bag of sorts. Like most people had said, there were some extremely long vignettes, scrolling down just to see the answer choices. Lots of labs, mainly used as distractors I think. I read the last line of the question, highlighted it, and then went to the beginning and started from there. I feel like the questions where the vignette wasn't related, and you could read the last line and answer it and move on saved me valuable time. Even some where the line was asking for a mechanism of disease, or a specific gene or something, I could read the last line, then go back and get the feel of what the patient had, then answer and move on. If I had read the 15 lines of the presentation paying meticulous amount of detail to everything, would get weighed down so easily. I feel like this helped.
So yeah vignettes are long here and there, would finish a block with about 5 minutes left, would go back and click through everything and maybe sit on one question I was really waffling on. That was about it. Heard friends who were finishing with seconds left, so at least I wasn't in that boat.
I felt the content was VERY very fair. Each block had your gimme's, had a question on treatment for an opportunistic disease we ALL know the treatment for, and took a double take, thinking that it felt too good to be true. Had your typical SOB/chest pain/crackles questions that were pretty murky to figure out what was going on. Your weird ethics questions. And then your crazy obscure minutiae questions. Had some enzyme questions and some tumor staining questions, and some genetics questions that I've never even thought of.
No drug ads. Probably about 6 abstract questions, good amount of biostats. 3 multimedia questions - all very easy. Lots of images.
Mine was VERY psych heavy. VERY. Not even joking, my first 6 questions were all psychiatry. I laughed out loud, it was crazy. And my second question was a diagnosis question I mess up EVERY time and am pretty sure I got it wrong. The name and subset has changed and no source is clear on what it falls under, thought for sure it wouldn't pop up, and there it was, staring me in the face.
Also the 2 part questions where you have to lock in your answer before moving on. I think I missed about 5/6 of these. They were extremely hard and difficult and I think they just put them in there with that difficulty to fluster you up. Many people I've talked to have missed a bunch of these. The presenting illness was usually nothing I've ever heard of, or a workup I've never considered.
Another frustrating thing was I had a LOT of double jeopardy. Had one weird illness pop up in 2 separate blocks, same thing with another, and biostats asked me for the same calculation about 2 or 3 times.
Another thing I felt was being harped on was alternative treatments, for example, not a question I had but how it would go: Patient X has Gonorrhea, but is allergic to cephalosporins, what do you treat with. Had about 3 or 4 questions like this where the patient couldn't tolerate primary therapy from what you would read in the stem, or it wasn't listed, so you had to know what was next best.
Took a break after every two blocks. Skipped the tutorial. Didn't write down anything on my sheet before hand, it wouldn't have helped. Had no questions on P450 stuff or QT prolongation or anything like that. So glad I didn't even bother. I used all of my break time too honestly.
I left the test feeling not too bad. Just tired and drained. Went home. I've remembered about 160 questions I had... and am 100% I've gotten 13 wrong, and another 20 or so I can't really tell.
All in all I feel confident. Just trust your prep. Manage your time wisely. And get a good nights sleep.
