Step

1/Level 1 Board Advice

Who am I:
I am from the Class of 2018originally. I finished 2nd year last year, but ended up taking
a Leave of Absence (LOA) before my third-year rotations beganso that means I will be
joining you guys/girls, the class of 2019, this June. My LOA was my own decision based
on my feeling of preparedness before my set board exam date. While my practice exams
predicted a passing score, it just felt like I would be underselling myself, and a standard
deviation above would be fine, but below would have been costly. As I mention below,
its my belief that an important predictor of success is starting and completing whatever
study plan you set in place. As for me, my first two weeks of studying, while they were
successful in the sense of I accomplished what I set out to do, it was not the most efficient.
Those two weeks set me behind. I moved slower through the rest of my material than I
had predicted. Even with the wiggle room I initially put into the study plan, I couldnt
recoup that lost time.
So what did I do wrong? Too much Doctors In Training (DIT). Yes DIT. I spent two weeks
of the dedicated study period listening and following along in First Aid. What I did right
was still doing questions every day, but the time I spent on videos could have been spent
doing more productive passes through FA and more questions. Yes, DIT laid the
foundation for excellent passes of FA afterwards, but in the end it kept me from
completing my own set study plan in the specified time. Had I not done DIT, even with
moving at my unpredicted pace I would have completed my study plan and moved on
with my class and started rotations. Not trying to knock DIT, but for me I should not have
done it.
DIT is good, and if you can get through it before the dedicated study time I would say it
does help focus your FA content, but it is not necessary to be successful on STEP1/LEVEL1.
Below is my experience with STEP1/COMLEX and how I would structure my study plan if
I had it to do over again. In the end, I moved my exam dates beyond the school deadline,
which didnt allow me to start rotations, but it all worked out for the best, as much as it
pained me to step away till this June. Dont let this happen to you, the school didnt want
me to do this and neither did I, but no one knows you better than yourself.
You will be getting all kinds of advice, and this is just my experience, and everyones will
be and is different, so take it with a grain a of salt.
There are much brighter and talented students than myself and probably have much
better advice and did much better on the boards, so take a look and listen to what they
have to say as well. Those who were able to make 3 to 4 passes of UWORLD is beyond
me, but that seems to be a theme for really high scores.
Im an average student, not in the top ten percent or anything like that, but Im also not
in the bottom 10% either. Ive been in good academic standing in both years, just to give
you some reference. For my boards, I passed on the first attempt with respectable scores
on both STEP1 and LEVEL1.
I look forward to meeting each of you. Ive heard the class of 2019 is exceptionally bright
and have followed along with the class on FB as time has allowed. I can tell the tensions

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 are rising as boards approach. All I can say is that you will be fine, and will have enough
time to prepare for boards during the dedicated study time, even if you havent been able
to do much during the school year.
See you all in clinical skills week. Good Luck!
If you have any questions feel free to message or email me.
thomas.bell@my.unthsc.edu or via FB



USMLE vs COMLEX
The biggest difference I found was that the USMLE was more about understanding,
while the COMLEX was more about knowing. Dont get me wrong you had to know a
lot for both, but it seemed that when it came to a sticking point of a question on STEP1
that I could more easily and logically deduce an answer, whereas on LEVEL1 you either
knew it or not.
Historically, STEP1 has been the harder exam and so I took it first. Everyone has
different experiences and versions of the test and maybe I got the hardest one, but I can
say that my LEVEL1 exam was easily 3 times harder than STEP1. LEVEL1 questions were
overall longer and more convoluted. That being said the level of difficulty once you
figured out what they were asking was about the same, though for me LEVEL1 questions
on average were a little more challenging. It was like the NBOME just opened Harrisons
at random and whatever they came to they decided to right a question over it. This is in
contrast to STEP1, where I felt at least that if you mastered the first aid material then
you were okay; STEP1 just seemed to be better organized and had a much smoother
flow. I would still take STEP1 first because it was more organized and logically oriented.
I feel like that if I would have taken LEVEL1 first I would have a bit of test vertigo, and
my thoughts going into STEP1 would have been rattled but this hasnt been the case for
everyone.
I walked out of the STEP1 exam feeling like, okay that was hard, but wasnt as beat up
as I planned on being, it was doable.
I walked out of LEVEL1 and thought to myself, okay, well thats it, Ive failed, my
medical career it probably over. It was an awful feeling, but to my surprise, I did pretty
well.

What to study for USMLE
First Aid: I would aim at least for what I call a soft pass before dedicated time begins.
By soft pass I mean, going through and underlining, highlighting, and/or adding notes to
each section, so when dedicated study begins then you will move through it quicker
during the hard pass or more active learning phase. Its not for everyone, but its
something I wished I had completed before the dedicated study time.
Pathoma: This stands for itself. I watched the videos and put in FA what already wasnt
there.
Uworld: Its just a mustbut you probably knew that already.

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 Anatomy: Learn whats in FA and UWorld. For muscle anatomy, I kept it simple and was
fine, look at plates 405-406 and 477-478 in Netters (6th ed). It shows the red and blue
like you see on the skeletons in OMM which gives the origin and attachments. That
covers the basics and every muscle type anatomy question I had on STEP1 related to
knowing those basics. Know the major arteries/nerves for each limb. For all other
important nerves and arteries (circle of Willis etc..), FA seemed to cover it acceptably,
just make sure that if its in FA, then know it like the back of your hand. Maybe review
some of the major branch points, thyocervical trunk, etc. But there will always be
something they ask that you would have no way of preparing for. Stay High Yield, the
rest seems a shot in the dark with anatomy.
Biochem: Stick with whats in First Aid.
Biostats: FA and Uworld. STEP1 biostats questions range from straightforward to what
the heck. Dont neglect this section, it can make an otherwise average score above
average. I should have spent more time here.
Radiology: There will be a lunch and learn type session with someone who reviews
radiology toward the end of the semester. I didnt go, but do download the slides. I
reviewed these in the few days prior to test day, and that was sufficient for me.
Uworld>>Kaplan>>TrueLearn. But do some TrueLearn for Comlex.


What to study for COMLEX
Everything above plus:
Savarese: Go through it like you would have with FA. Make sure you know the
fundamentals well. Go through one of their sample exams and answer those questions.
It doesnt take long, but I found that there were some simple points I thought I knew but
either didnt, or had forgotten.
OMM: Review the major set ups/Dx for sacrum, cranial, and ribs etc... They seemed to
have liked cranial and ribs for my exam, with sacrum not far behind.
Even after reviewing for the OMM above, a lot questions (I had) were unlike those I had
seen at TCOM. 50% were typical and the rest were a step or two above the norm.
Dr. Crows review book: I looked through it and sampled a few questions, but thought
Savarese was more straight forward and easier to read, more efficient. But thats just
me, we all learn differently.
The following was sent by Dr. Reeves to our class via email. Its a link to a youtube on
viscersomatics. I think your class has learned it this way this year but its something you
should know. http://www.youtube.com/watch?v=N-r_QriTMSc
Chapman points: Take the time to watch it and draw it, then study it. Once you have it
on paper then just review. https://www.youtube.com/watch?v=EWPw4G5QGcA
Chapman points did show up on COMLEX and can make for an easy point, just have to
know them.

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COMLEX as I knew it
As mentioned above I walked out thinking I failed, completely smashed. I kept
wondering if maybe they gave me a LEVEL2 exam by accident by the way some
questions were asked. Keep your wits about you though it will help you in the end.
Something you guys/girls are doing that we only did for Capstone was MindMaps. The
thing that kept going through my mind during the COMLEX was, I sure wish I had a
MindMap for that. You have that in your favor in the way each of you have been
organizing throughout the semester.
If you ever felt like the curriculum (or at least its delivery) at TCOM is a little chaotic,
erratic, or other adjectives, you are not the only one. Whether it is done intentionally or
just a happy accident, this is the way the COMLEX can feel, just kinda all over the place.
When it comes down to it, TCOM is doing a good job at preparing you for the COMLEX.
The guy from onlineMedEd said it best, most people survive medical school not
because of their curriculum but in spite of it. I would say hes pretty spot on, but also
think TCOM has put a lot of work into it and is doing better than most.
Neuro, Neuro, Neuro! Felt like 80% of my test was freakin Neuro! I thought it would
never end. There was stuff on there I had never heard of or read about. Stay cool and
stick to what you know and work through it. Dont take those frustrations to the next
section.
Fair amount of Micro. Ob/gyn, Ob/gyn infection, and GI seemed pretty prominent as
well.
Ethics: This also felt like stuff you either knew or didnt and had no way to prepare for.
Some crazy questions on legalities. In addition to whats in FA, look for questions that
ask when you can and cant refuse patient care and similar scenarios. Dont stress out
too much about these questions, I waited to do these last to pick them apart.
Biostats: The only part of COMLEX for me that was more straight forward than STEP1.
FA biostats covered all I needed.
It comes down to making sure that you understand what you learn from each of the
resources you use and be able to apply them. Thats the material they really want you
to know, and my feeling is that if you know that much, you will pass, despite the crazy
stuff they throw at you.

Practice tests for Step 1:
Besides the school administered NBME here is my assessment of the other NBMEs:
NMBE 13: my first one (besides the schools); establish baseline.
NBME 16: took halfway through to monitor progress.
NBME 17: Most predictive of my score, other reviews say NBME 16 was more
predicative for them. Taking the average of the last two or three is a good reference.
NMBE 18: Took one week out. Was the hardest of the NBMEs and the questions were
longer than the other NMBEs. Despite being harder, this was my highest score. Despite
not being as predictive I still say take this last, because you want to go in with the last
thing you saw being really difficult, so the actual exam wont seem quite as bad.

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 Uworld practice exams: only used it for COMLEX practice, but very similar to real thing. I
still preferred NMBEs because despite the shorter questions, the root questions were in
my opinion more challenging.


Practice test for COMLEX:
The school administered exam from the NBOME was the better COMLEX practice exam
by far. I think it can give you some idea of where you are at and what you need to
study. Look at those metrics to help guide your studies.
The other NBOME exams you can purchase are a complete joke, unless they have new
ones out since last year. I do suggest you take one but dont let it be the last thing you
see, I think I took Exam C, just to get some familiarity. I almost stopped halfway through
because it seemed a waste of time, but you be the gauge of it. Somehow, my real score
was close to that one, but Im not sure how because it was just ridiculously
straightforward questions.
Just make sure you familiarize yourself with COMLEX format with TrueLearn or other
method of choice.


Sample study schedule if Taking Step 1 and COMLEX
Before the dedicated study time have these things done first:
Chapman points: see video link in sections above. Make notes and have on hand for
later. It will only take you thirty minutes max to draw it out and have it ready to study
for later.
Viscerosomatic: see video link in sections above. Make notes and have on hand for
later.
The videos are something that you could probably do on a free evening some weekend,
wont take long.
Savarese: Go through and annotate/underline/highlight (whatever you do) once.
Get through as much FA as you can. Each pass gets faster.
Do as many TrueLearn questions as you can in the test mode where you can simulate
the actual exam and select osteopathic oriented questions. Although Uworld questions
are better, seeing how TrueLearn incorporates viscersomatics into questions is a big
help for the COMLEX and I do think is a must so you will not be surprised on the exam.
If you can get through enough of them, then once dedicated study begins go on to
Uworld and dont look back.

During the dedicated study time:
Uworld questions: Questions in timed mode and review those questions when done.
Annotate what you can into FA where you feel necessary. Spend about 6-8 hours per
day doing questions along with annotation if needed.
Try and set a pace to get through UWORLD twice or qBank of choice.

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 The next 4-6 hours: Review FA and weak areas. My advice is to try and make two
passes before test day.
Study time per day 12-14 hours. Its rough but doable.
In the couple of days before the exam review anatomy and radiology, see comments in
sections above.
Take an NMBE halfway through, two weeks prior, and one week prior to test day. (See
specifics in sections above.)

For the days preceding the COMLEX (if taking last):
Go through savarese and look at the points you previously outlined/highlighted. Take
one of the practice exams in back (Those dont take long.)
Review Chapman points and viscerosomatics. (Wont take long if you follow my
instructions above and have already watched video and written out notes.)
Review major OMM techniques.



Day of Exam:
I took my STEP exam in the afternoon so I did the following:
Went over some drugs in first aid that had a hard time sticking, reviewed quickly my
chapman points (before comlex).
Gave myself about 15 minutes before I walked in the testing center to close my eyes,
meditate, and clear my head. Leave everything behind you and know that you are
prepared.


If taking just the COMLEX:
All of the above still applies.



Bottom Line:
Print out a calendar and set your activities with what you need to get done each day to
be ready and stay on that pace.
Everyone has a different test experience and versions of the test given on any single
day. Some may get hammered with a lot of Neuro or possibly anatomy or something
else, etc... You have no way to know so try and grasp each of the concepts you have
learned.
My experience it that you should complete whatever plan you set for yourself.
Once I completed my study plan and took a practice exam, my score was increased
dramatically compared to the practice exam the two weeks prior. Stick to it and finish.
Lastly, do what works best for you, listen to the advice of others, and take away what
you know is manageable and realistic for your study styles.

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Best of Luck,
Thomas Bell