Experiences

Took my Step 1 this past week. I'm not sure how I feel. The questions
stems were not any longer than UWorld. I would finish a block of
UWorld with ~15-20min to spare, I finished blocks in my step one with
~10min to spare. What threw me off was the content of my exam. I
don't want to risk being overly specific but I felt I had very little
straightforword biochem, gross anatomy that was mostly
straightforward with 1-2 completely left field (no crazy neuro or pelvic
anatomy), very little physiology (no math but definitely a handful of
arrow questions), and as far as path, the questions were not overly
specific (no need to memorize the nitty gritty details) but they were at
times super vague. Another thing that surprised me was that there
were no sequential problems (where you're locked in on a question
before you proceed). I'm a pretty liberal marker and marked 10-15
questions per block feeling absolutely unsure of ~5 questions per
block. My study strategy was UFAP + Sketchy (definitely more than
enough content wise, I believe the difficult questions on this exam
stem from your test taking abilities). I did UWorld (unfortunately the
questions seemed much more vague and not as clear cut as UWorld),
a little Rx (no opinion), NBME 15 & 16 (representative of most but not
all in terms of difficulty), and the free 150 (this was too easy). As far
as my scores: UWorld avg in the 80s, baseline NBME in the 220s,
NBME 4 weeks out in the 250s, free 150 90%. My one regret is not
knowing my pharm cold. I'm sure I missed a few easy points bc of this
and hope I didn't screw myself over =.

I took it today and somebody asked for a 1st reactions post so here goes.
Difficulty: First off, I thought the questions on my test were, for the most part, easier
than Uworld/Kaplan/NBME/UWSA/CBSE. 50% of questions I thought were very
straightforward, 30% were challenging, and 20% were very difficult. I would say Uworld
is a good match for the challenging questions, and then some of the very difficult
questions, but they'll always have some out of left field questions on step and I saw
some. I'm a very liberal marker, marking anything I'm not positive about, and I marked

about 11 per block (15 on my two hardest blocks). Probably had 5 each section that
were actual guesses and then the others I just couldn't rule out another answer.
Content: The question stems were pretty identical in length to Uworld. I had quite a few
pictures on my exam, but not all were necessary in coming to a diagnosis. I'd say in
order of prevalence (CT>histo>gross anatomy). I did have some pretty difficult
anatomy questions (as opposed to stargazing's post) which I didn't recognize as being
in FA, but I haven't taken the time to look. I didn't have too much biochem, but it
wasn't all extremely straightforward like I heard it had been on others tests, some were
simple, but some were very difficult. I had plenty of physiology arrow questions and
some other general physiology, but nothing like the in depth equations you see in FA. I
also had a lot of scenarios of what to say to patients. I felt like my ethics sections was
more difficult than my Qbanks (I didn't take NBME 17 but I assume from what I've
heard something like that), but most were straightforward. I only had a few molecular
genetics questions which was nice (except I had one completely out of left field). I only
had 2 audio questions, and no organ system felt overly tested in comparison to others.
Timing: Timing has never been an issue for me throughout my education or in test
prep. I had PLENTY of time for each block, and had more break time than I started with
despite taking 5 breaks. Skip the tutorial, friends.
Snacks: I highly recommend honey crisp apples. A nice tart punch in the face to wake
you up between blocks. I also did ham sandwich halves (1 per break), pretzels, and
soda/water (about 8 ounces of soda per break). I tried to do a lot of light snack breaks
rather than a few big snack breaks, because when I eat too much I go into a coma. My
strategy worked because i really never felt fatigued despite never having taken seven
blocks in a row before.

I had one b12 deficiency leading to neuropathy, but it was by symptom not cross
section. Also had a CN palsy with brainstem gross anatomy

So I took the exam today and well, for the most part A LOT of the information was in First
Aid (~90-95%). There were actually even a few questions that were straight regurgitation of the
random facts that youd possible skip over/disregard and say "there's no F'N way that'll be
tested", which is a statement I used to often say before I started doing the NBMEs. So if I had
one piece of advice to give, its to GET TO KNOW YOUR FIRST AID inside and out. There
is absolutely no other book that is a better bang for your time if you will. It literally has the
answers to so many tests questions its ridiculous. I say to say this
however; UNDERSTANDING FA is key each and every line, period, exclamation point,
whatever. If you dont know what something is, how it looks, or the pathophysiology isnt

explain in FA LOOK IT UP, it will serve you wonders when you take the actual exam. Dont
be lazy its a huge book filled with a seemingly insurmountable amount of information, but the
answers are LITERALLY at your fingertips (or eyeballs if youre using a digital version). Become
one with the book to the point where you can regurgitate it in your sleep. Step 1 (at least my
form) seemed to be more of a test of how fast can you figure where this line of FA is? so in
the end, he who knows (and UNDERSTANDS) FA like the back of their hand will do well;
dont underestimate the power of this book! Ill write up a more detailed review later, for now
its time to go drench the memories of the last few weeks in EtOH. As a guide of reference for the
numbers-oriented, my (approximate, so that I can retain anonymity on this forum) practice
scores are below.

just took the thing. i appreciated when people posted their experiences so i'll do mine.
sorry if this is rambling but hopefully it's helpful. the test was honestly pretty fair
overall, some weird questions but nothing too crazy. i feel like i should feel worse about
it so that has me a little worried.
the questions were on the whole pretty similar to uworld questions, lots of arrow
questions and about three murmur audio questions. only one step 2 style questions
about next step management (iv fluids vs bicarb vs abx for severely dehydrated child
with shigella). i had zero metabolism pathway questions, anatomy was manageable and
mostly the same as was covered in uworld, and neuroanatomy was extremely
manageable. very glad i didn't waste time poring over brainstem slides trying to relearn
nuclei.
i pounded bros cards on glycogen and lysosomal storage disorders and vitamins for the
past 2.5 months and was very happy i did that as that was the bulk of the biochemistry.
the ethics questions were easier than uworld but there were about three insurance
questions and the joint commission that i feel like i had to make an educated guess on.
biostats was not too bad, first aid was more than enough.
i had at least two questions that were almost verbatim from uworld so that was odd. of
all the organ systems, endocrine was the most high yield for my test, so know hormone
pathways cold. pharm was not as bad as i was expecting which was a pleasant surprise
as pharm is my weakest subject.

i took the entire 8 hours today even though im a pretty fast test taker generally. i
looked up some things i wasn't sure of on my breaks and at least twice it netted me a
question on the subsequent sections so i wouldn't shy away from it. maybe i'm just an
idiot but the program looked like exactly like uworld and not like the nbme's which was
a pleasant surprise.
throughout the year i did bros cards nonstop throughout each block but did not keep up
with reviews after, and that was perfect. a few questions i got right just by virtue of
seeing it ~10 times during that specific block. i got through pathoma twice during the
year (twice during each block), and first aid twice (once during the organ blocks, and
then once in the three weeks leading into dedicated). during dedicated i got through
half of pathoma (weak areas) and fa only once but didn't feel like i lost anything by
doing that (hopefully). sketchy is a godsend (both pharm and micro). i only did
ufap+sketchy during dedicated and never opened another resource.
i'll repost this when i get my score back but here are stats: 68% uworld first pass (56%
over my first ~6 blocks or so), 72% after doing incorrects. nbme 16=215 (one week
in), cbse=230 (two weeks in), nbme 17=232 (2.5 weeks in). took 5 weeks for
dedicated and felt that that was more than enough

The test was a mixture of all disciplines. Had some odd Immuno
questions (age related decline in immune function, very very specific
on exactly what occurs...), a few biochem... some basics, some
convoluted questions, lysosomal storage diseases. Had at least 3-4
behavior science/biostats/study design questions per block. A mixture
of renal, CVS, and lung physio/patho. Roughly 15-20 microbio related
questions, some of them were quite difficult (hence some people
recommending SketchyMicro), but I felt confident in my answers
having used Uworld/FA extensively. Could have been wrong on some
of them, but oh well... Know the receptor stuff from UWorld
(insufficient in FA15), the second messenger systems, tyrosine kinase
etc. Tedious details but I had a few related questions. Be familiar with
autonomic pharmacology.
Hi everyone. Thanks for all the support. I've found this thread really
useful.

I took the beast today. I'm tired haha, but I know some of you all have
exams coming up and want to hear about it. Here we go:
My first block was insanely EASY (easier than any block ive seen on
NBME 15, 16, 17, UWSA1 and 2). The block was basically regurgitation
of HY first aid facts. I finished it in 35 mins, and I never finish early. I
was beginning to wonder why people were posting horror stories
...
That was, until I reached the next three blocks. These were the
HARDEST blocks I've ever encountered on any of the above exams. It
was difficult for multiple reasons. First of all, there were a lot of
random facts thrown in from diseases I've never studied, to drugs I've
never heard of, to random biostats, and random anatomy. Some of this
cannot be found in Golijian, FA, UW/Rx, NBME, sketchy, etc... i.e. any
commonly used resource. It is almost as if they specifically went out of
their way to bring in random material outside of these resources.
Doing well in class comes in handy to have a wide net of knowledge. I
even had a random ethics question that had me scratching my head.
The second and perhaps bigger problem with these blocks was the
addition of clinical value based clinical questions. They may ask "what
is the next best step? " They may ask " of the drugs which is the best to
add?" They may ask, "which of the risk factors or predisposing
conditions is the biggest contributor to a pathology." I definately
guessed on these. I saw no pattern and have no idea how to prepare for
it.
--The last sections were toned down some bit and felt like UWSAs oddly
enough. A mix of straight forward with a bizzare questions every so
often. A lot of the application questions were here as folks have talked
about. Sometimes, they may have a huge graph, chart, or a very longlooking question, but they are actually quite easy if you carefully read
the question, so don't be intimidated by them!
I didn't have any issues with timing. I wouldn't have done anything
differently in the last week ( i read FA)

As I said before the exam felt doable, lots of questions of behavoiral

sciences 3 or 4 per block, 11 questions about calcium metabolism, 10
pathology pictures, 2 EKG's , 2 murmurs, 3 or 4 WTF type questions, 3
0r 4 questions exactly , even word by word from Uworld. I think most
of the exam is in Uworld and First aid.
Exam Experience: my short term memory is terrible. now this is advantageous
when taking an exam like step 1 since like me you can rapidly forget about the
previous block and then focus in on the next one which is very important folks,
never let the previous blocks experience linger since you have 300 + questions to
get through and you need to maintain a high level of focus throughout.
However having a short term memory is terrible when you really want to be
able to tell people what topics showed up but honestly cannot remember (sorry
folks). I just remember thinking each block I was marking more and more
questions. I had a lot of ethics and biostatistics type questions which
unfortunately was one of my main weaknesses. I probably had 3-4 questions
per block. In my score report I was borderline for biostatistics/population
health which disappoints me a little because had I answered a few more in this
category, I probably would of hit 260.

I took Step One on June 23rd of this year. Overall, I thought it

went pretty well on test day. I took 4 blocks of questions
consecutively, took a ten minute protein bar/restroom break,
and then took the last three blocks consecutively. I was
finished with the exam at 2:15--so it was a pretty rapid-fire
experience. I felt as though my test was very heavy in
immunology and behavioral science/ethics, which was OK
because my research is in tumor immunology and I'm
working on my masters in bioethics.
Yup. The only ones that I felt I could have used, which weren't there were LDL, HDL
and TAG.

However, I can truly say that almost everything that came across my
screen was something I had seen on Uworld, USMLE-Rx, or in class.
(doesn't mean I remembered it all!) FA does NOT cover everything.
Some nit-picky details would either just have to be memorized from
somewhere like a comprehensive review book or guessed. Also, there
were tough things that someone with clinical experience would have
no problem with (like hospital safety and patient admission and
prevention) that most medical students like myself are clueless about.

The questions are mostly do-able though.

TIME was my biggest issue- normally I have no problem finishing with
minutes left over and I consider myself a fast test taker. However, this
was different. I was pretty much racing the whole time, because even
though they give you some shorter questions even those are still
thought provoking. I found myself having to really THINK THROUGH
the things that I knew. Also, the heart sounds take up some time, and
analyzing full ECG's takes time unless you're a pro.
There were also some freebies thrown in that are easy and make you
feel good (unless you psyche yourself out and miss them, which did
happen to me bc of the time crunch!).
The most challenging questions seemed to involve lab values similar to
ones on UW. The style of questions is the vignette with columns and
arrows. Those damn arrows go both directions for every column and
its very easy to get confused. Also, it sucks when you don't even know
how to interpret one of the columns. So I highly recommend getting
very familiar with labs in common clinical situations (ex. ESRD, DKA
etc) so that you don't get messed up on the test and waste time going
back and forth. Surprisingly, I also thought there was a fair amount of
anatomy on my exam.
My bf took the test on the same day in a different state- we had some
of the exact same questions, but not all. He said his test was heavier in
neuro than mine seemed to be. Neither of us really felt like we got to
use all that micro knowledge we memorized...
Anyway, this post is really for the people like me who had anxiety
before the exam. If you are performing decently well on UW and
NBME's, just do it. You know more than you think and the test is
designed to allow you to show that.
Exam Experience: Oh yes, the thing that everyone wants to know.
Take this with a grain of salt as everyone has different forms, and you
won't get the same form as me (even if it is helpful). The exam was
very similar to the NBMEs with a couple UWorld like questions and a
handful of WTF questions (about 2-3 per block). The exam I would say
was 80-90% UFAP. Don't worry about the random other stuff on the
exam. Just go with your gut and move on. Some of the WTF questions

could only really be answered with knowledge from my clinical years

which I thought was really unfair for people who don't take it after
clerkships. My exam was extremely psych, renal, and rheum heavy,
and I wanted to bang my head against the wall while taking the exam
as these are my 3 WORST areas. The stems were also a little bit longer,
and I was definitely had some less time to do my blocks. I normally
finished my NBME blocks and UWorld blocks with 25-30 minutes left,
but on the real deal, I only had about 10-15 minutes. In terms of
systems:
Anatomy: Yes, everyone is scared of this. My form had about 10-15
questions total, and FA was enough for most of them except for 2
questions (both of which only an ortho could answer).
Biochem: Very straightforward. Not many questions. I was kind of
mad about this because I spent so much time with biochem, but not
much showed up and most of it was biochem diseases.
Micro: Omg, I had SOOOOOOOO much micro. It was just like wtf the
whole time. Thank goodness for Sketchy Micro because it saved my
butt on a ton of those questions. A lot of it was straightforward with a
couple headscratchers.
Immuno: Not much at all. Maybe 5-10 total. And most of it was
straightforward.
Embryo: Not too many questions. Maybe 5 total, but the ones that
were on there were actually some of the hardest questions on the exam
and were more second to third order and not a regurgitation of
branchial pouches etc.
Behavioral/Ethics: Some of this was really, really hard. Very mixed
stuff, and you get stuck between 2 answers but you just have to go with
your gut and move on. There weren't that many on my exam anyway.
Biostats: Not much. Had one WTF questions here that only someone
with a stats degree could answer. Otherwise, FA was enough for my
exam.

Pharm: Very straightforward on my exam. FA covered 95% of pharm

on my exam. Most questions were more geared toward side effects
(which was a strength of mine given I had seen a lot of these during
clerkships).
Path: Obviously a big chunk of my exam. Like I said, my exam was
very psych, renal, and rheum heavy. (Also pulm heavy). Out of these
four, rheum was extremely heavy on my exam (which I was surprised
about because rheum is generally low yield). I wanted to break my
computer, but thankfully rheum was manageable and relatively
straightforward with a couple WTF questions. Psych was the second
most heavy next to rheum, and it was also straightforward. Renal and
pulm were pretty equal, and these two had the harder questions. There
were a bunch of mixed presentations of renal and pulm, and like some
people said before, some of the questions would go in one direction
and then start going in another direction and then go in a third
direction. Clerkships were helpful for this because a lot of Step 2
material forces you to parse out diagnoses and split between hairs.
Otherwise, all other systems were low yield (including neuroanatomy
which I was surprised about. Neuroanatomy was probably 3 questions
on my exam.) There was a handful of basic path questions, some of
which was WTF and others were straightforward.
Physio: A ton of physio (endocrine wise). Almost all of it was
straightforward with the exception of one WTF question that I just
stared at for 5 minutes and gave up because staring at the question
wasn't going to do anything.
Other stuff: Not many CT scans/X-rays etc on my exam. One question
had an abdominal x-ray but it didn't even show anything and I didn't
need it to answer the question (I hope haha). Had 3 EKGs, and it was
surprising because people universally say EKGs are very
straightforward on their exam, but 1 of mine was WTF and I only knew
it because I did a cardio elective. Had two heart sounds, both of which
couldn't really be answered with the stem so I had to listen to them.
Good quality I have to say. Sounded exactly like a real patient. Had a
couple repeats from the NBMEs and from the Free 132 (or were very

similar). A couple questions were also very similar to UWorld also.

One of my questions was literally sentence for sentence out of FA, and
I thought I was reading FA for a couple seconds. Makes you wonder
who's writing FA.... UWorld also got me a question wrong haha. But
whatever.
Post-Exam Experience: Felt relatively okay coming out. Wasn't as
crazy as some people had said on here. But it was bad that night and
the following 2 days. I started to look up random questions and found
out I had about 4-5 stupid mistakes/overthought some things. In the
end, I had a list of 13 wrong with 8 that I was unsure of. I would highly
recommend taking a vacation and getting away from social media
because it really helped me. I went to South America and did a hiking
trip for 2 weeks with very little internet and was able to get away from
thinking about step. But this week, I started having flashbacks of
questions and would look up random things from my exam again (and
I also thought I misread a bunch of questions). Definitely not good. In
the end, I would say I got anywhere between 30 and 40 wrong on my
exam.
Anyways, this is long enough. Hope this is helpful to everyone else
taking this exam soon. Let me know if anyone has any other
questions!