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My USMLE Step 1 journey

I am Dr. Alnoor from Pakistan, YOG 2013, got 241 in step 1. I received many
queries regarding exam and my study plan. I would try to answer as per my
experience and observations but before that let me share some key points
about USMLE:

USMLE step 1 is difficult but doable exam and if you have WORK
HARD SMARTLY, you can achieve 240+.

There is no official standard book of USMLE. FA and UW cover 90-95%


content of exam. Almost all of us use these 2 resources for preparation
but some get score in 220s and some get in 260s. The difference is due
to the manner of study. Let me hare my experience.

I started my prep last year in Feb and appeared in April 2016. I was doing job
along with my step 1 prep thats why it took 15 months for me but I think 6-8
moths should be enough if you are consistent. Resourced that I used are
following:

Anatomy: Kaplan, Hy anatomy and embryology, Netter for brain images

I didnt watch Kaplan lectures for anatomy and histology. Anatomy is the one
subject that I think is not covered completely by FA and UW. I had few
questions in exam that I had no idea about. UW covers histo well so dont
worry about that.

Neuroanatomy: kaplan, HY neuroanatomy, Neter atlas and google images

I think I did a mistake by not watching lectures. I read kaplan and HY for few
topics like cranial nerves and blood supply. Know spinal tracts pathway,
blood supply of different regions and their integration with different diseases
and stroke. You should be able to identify the location of lesion by reading
signs and symptoms. Look for labeled brain images. Do CNS drugs well
particularly antiepileptics.

Biochem and Genetics: 2014 kaplan lectures by Dr. Turco, Kaplan, HY cell
and molecular biology.

Dr Turco has explained biochem concepts very well. The main part here is
integration of normal and abnormal biochem process with disease process.
For e.g.: anaerobic glycolysis in abscess and suppression of TCA cycle in
hepatic encaph. For genetics I did kaplan and Hy cell and mol bio. To
understand genetics you need to love it first :D Practice its questions from
kaplan q bank and UW to clear basic genetics concepts of hereditary traits.

Physio: BRS, Dr. Wilson Kaplan 2014 lectures and kaplan

Physio is just concepts and extensively asked in exam either with its
integration to pathology or pharmacology. Dr. Wilson has explained
integrated concepts well. I read BRS after my UW 1st pass because my
performance was poor. Bottom line is that understand and learn physio well.
USMLE exam tests your basic concepts and ability to integrate it with clinical
conditions. BRS is good book but extensive so dont try to memorize it but
understand it.

Immunology: Kaplan and FA.

Very interesting subject for me but I felt it more difficult than any other
subject. Questions were not straight forward so learn the basic functions of
different component of immune system and their role in disease.
Immunodeficiency diseases are very HY topic. Lean it by heart.

Micro: Kaplan and FA

I think FA is more than enough. You should catch the hints of bugs
characteristics to get straight to the answer. Learn Micro pharma and their
mechanism of action and resistance.

Pathology: Pathoma, Dr. Sattar lectures and FA

Major part of exam. I watched pathoma videos once and read pathoma twice
along with UW and FA. I didnt read Goljan so cant comment about it.

Pharmacology: kaplan 2014 lectures and kaplan, FA is enough though with


lectures.

Most of it is just memorization. Exam questions focused on mechanism of


actions and major side effects of drugs.

Behavioral science, Biostats and Psych: kaplan 2010 lectures, kaplan


and FA.

Ethics part is tough and it is so subjective that the only way to learn it is that
practice its questions a much you can. You have to develop an insight and
understanding of US ethical standards and practice. Same goes with
behavioral science and psych. Learn anti psychotics by heart and their
collective and individual side effects with antidotes. Duration of signs and
symptoms is crucial for differentiating among different disorders.

Q BANKS:

The key to score high is to practice as much USMLE styled questions you can.
This is the only way to assess yourself that how much you have understood a
particular topic. I initially used kaplan q bank but didnt complete it. After
read kaplan and FA once I started UW. If I had read FA twice thoroughly
before starting UW I would have given my exam in Feb. The reason behind it
is that FA covers almost 90% of USMLE content. If you have understood each
and every line of FA then you would perform better. Key is to understand FA
well. If you are not clear of anything then read it from any review book.
Remember USMLE tests you on your understanding of basic science concepts
more than simple facts. Start UWorld when you have read FA cover to cover
atleast once.

When you start Uworld, keep in mind that its a learning tool. I started with
random timed blocks. After finishing 10-12 blocks I did system wise to
improve my understanding of individual systems and with that I was able to
read that particular system from FA. So I covered Uworld system by system
till the end. My average was 70%. While reading explanations, focus on the
points that were necessary to answer that particular question. Uworld has
explained everything in detail and covered almost every topic that could be
tested in exam so make sure to learn it effectively. When you get a question
wrong, ponder upon it that why you marked it incorrect. Either it was due to
lack of knowledge or understanding or you didnt understand the question.
Develop the art of solving USMLE styled questions. In exam you will face
questions that you wont understand what patient had actually but your
clarity of concepts will help you to solve the most difficult question and
clarity comes by practicing more and more questions.

Other Q banks I used were First Aid Q and A and Robbins review for few
pathology topics like hematology, kidney, pulmo and repro.

After completing UW once I gave NBME 15 online and scored 213 2 months
before exam. I realized that I had not read FA well because most of the
questions that I marked wrong could have been right if I had read FA
thoroughly. So for over next 5 weeks I read FA, BRS, Hy for anatomy and
embryo, pathoma along with UW 2nd pass. My aim was to understand
everything whatever is written in FA. I focused more on week areas and then
gave UWSA 1 and scored 232. I got some confidence and continue with
remaining topics. Then I gave nbme 17 3 weeks before exam and scored
247. This is how I improved my score by working on the understanding of
basic science core concepts and their clinical integration rather than just
memorizing FA. Memorization is important but without the clarity of concepts
it is of no worth. Nbme 18 one week before exam 241. Nbme 16---230 amnd
UWSA 2---242 both on the same day two days before exam. I didnt get
distracted from nbme scores rather I focused on mistakes. People read Fa 6-7
times but they dont score well is because of 2 reasons according to my
opinion:

1: They might have not practice enough questions

2: Going for exam without clarity of what you have read.

Its the clarity of your concepts that help you to answer most of the
questions, not just the memorization. This is actually what I meant my HARD
WORK SMARTLY. Every one gives their maximum efforts but it is your
approach that gives you an edge. Everyone has different background and
learning styles. Do not follow me or anyone else blindly. Make your own
strategy the way that suits you. When you think you are ready, just go and
get done with it. Dont delay it or your graph will go down but dont
compromise on scores. This is the most difficult exam and once you are done
with it, you will have a sense of accomplishment.

I hope I have cleared many queries, if not then ask anything you want to in
comment box below.

Thanks. All the best and cheers!