dedicate this post to my family, my teachers(from both my school and college), Dr. Srinivasan. Without the support of my mother and the rest of my family, this wouldn’t have been possible.
In this post I will write my story, how a guy without any doctor among his extended family, no one to guide him, just by sheer determination, hard work, and browsing the Internet cleared the Step 1.
This thread is all about my opinion, during/after reading this you may think I am arrogant, you may find it unnecessarily detailed, but I DON’T CARE.
If I had sent myself this email three years ago, it would have saved me a lot of time. This is going to be a long post, three years of my life sandwiched into this thread, so take your time, but I can promise you that you won’t regret it!
So like anyone else’s opinion I would suggest you take it with a grain of salt, modify it and use this in your way or ignore it altogether, we all are unique so find whats best for you! So this is my humble story.
I am a 3rd-year Medical Student from Kolkata, India. During my first year I came to know about this exam called USMLE, and after that, I tried googling what it is all about.
After a few days of skimming through useless search results and forums, I came across USMLE-FORUMS and started reading the Recommended Step 1 Threads.
During my first year due to lack of guidance, I could not implement the USMLE materials in my study schedule, but I made it a point to include all of them in my 2nd Year.
The 2nd Year in Indian MBBS curriculum consists of one and a half years, i.e., 3 semesters and it was ample time to revise all of my first year subjects as well as do my second year subjects, but this time instead of doing all this from Indian authors(which my peers prefer) and “the big foreign books”, I started using USMLE prep materials and solely relied upon them to help me through my 2nd year (List will be provided below).
Apparently, before my college exams, I used to consult the Indian authors and prepare the essential questions that may come in that exam, but I never let college exams become my primary focus instead I studied from Kaplan and Pathoma and supplemented from Shanbhag(Indian author) and Robbins(Basic) when necessary.
During my 2nd year, I had almost covered every subject, i.e., revised Anatomy, Biochemistry and Physiology and also did Pharmacology, Pathology, and Microbiology.
It was tough but manageable if one is willing to put in the effort and sacrifice. So at the beginning of this year I only had Behavioral Science and Biostats left, which I finished in two weeks and then I planned to take my exam during the period July-September, July is my target, but I ended up taking it on Sept 7th, 2016! Below I will go into details about what I did during these three years.
So without beating around the bush lets get started,
The Materials I Used during the first two years (I will describe all these later in my post)
- Anatomy: Kaplan Anatomy Video Lectures and book, High Yield Anatomy [Note: Neuroanatomy from Kaplan also, I did not find High Yield Neuroanatomy to be High Yield]
- Physiology: Kaplan Physiology Video Lectures and book and BRS Physiology book
- Biochemistry: Kaplan Biochemistry Video Lectures and book
- Pharmacology: Kaplan Pharmacology Video Lectures and book
- Pathology: Pathoma and Goljan Audio Lectures and book(Rapid Review Pathology – selected topics only)
- Behavioral Science: Kaplan Video Lectures and book
- Biostats: Kaplan video Lectures and book and UWORLD Biostats review
- Microbiology: Clinical Microbiology made ridiculously simple and Kaplan Video Lectures and book
- Immunology: Levinson(only did the immunology part) and Kaplan Video Lectures and book
With that out of the way, I will describe in detail what I did during these three years, so if you thought the intro was extended, by the time you would finish this post your hippocampus might herniate due to the immense detailing of this post
The Journey – Proper
As I said before I didn’t know about all this during the first six months of my first year otherwise I would have done things differently.
In India we focus on minute details and often miss the bigger picture i.e. someone may remember the course of the vertebral artery through the transverse foramina present on the side of the cervical vertebrates but forget the branches of the arch of aorta or the clinical features found in the lesions of brachial plexus, at least that was my case, due to the unnecessary detailing I lost the bigger picture, and this was the case in all three subjects – anatomy, physiology, and biochemistry.
During my second semester, I was lucky enough to come across the Kaplan Video Lectures and started doing the physiology and biochemistry lectures.
I would like to mention that I was not sure about giving USMLE that time, so I only skimmed through them and was surprised with the logic and scientific reasoning provided in these lectures, while in my college the teachers(most of them with few exceptions) just read out facts without any reasoning at all.
During this semester I was able to view all of the three subjects once and take notes as I did not buy the books but my approach was not aggressive enough, and I only tried to do the topics tested in college from these lectures.
I gave full attention to my college exams and not to USMLE, and that was not the right approach, which I rectified in the second year. I passed with honors in physiology and biochemistry and near honors in anatomy(I don’t regret not getting honors in anatomy as I didn’t focus on the bigger picture but instead tried to impress my teachers and peers by the minute details which I would forget anyway two weeks after the exam).
I would like to thank Conrad Fischer, Robert Dunn and Wazir Kudrath for helping me grasp some crucial concepts in physiology, also thanks to Lionel Raymon, David Seastone and Sam Turco for making me strong in biochemistry as I ended up getting highest marks in college.
Although in the first year I got good marks in college, I was not happy with my knowledge base and didn’t want to repeat my mistakes like “not getting the bigger picture and getting bogged down with minute details.” So to avoid this, I did two things –
1a. Didn’t buy most of the local Indian authors my peers purchased (most of the books are poorly written and copied from different foreign authors) – later bought only a few and that too for supplementary use
1b. I bought the big names like Katzung and Robbins (but only used them sparsely)
- Made my USMLE prep materials my primary resource which I was going to use in the next three semesters. That was a bold move for me, as while my peers were relying on private tuitions while I was studying on my own for “the” test people take after passing MBBS after all the clinical subjects, and no one was there to guide me about this, but I found the method by which the lectures taught you somewhat appealing and went on with it, this later proved to be a right decision.
The second year was filled with ups and downs as I was slowly making my mind to pursue USMLE, but there was a big hurdle in front of me.
In India, if you try to do anything different people will criticise you and give you examples of people who have failed before you, knowing this general trend I kept my thoughts to myself and didn’t share anything about all this with anyone, which later proved to be a right decision.
There was tension in the family when I told them about this test, the next year two seniors specifically warned me about getting low marks in Step 1, lost many friends to this cause, had to let close friends go who didn’t share the same dream.
Gave up most of the social interactions, attending parties, hanging out, deleted social media accounts. Although people might argue that I should have taken a different approach, I felt it was necessary to back then and I did it. Still today it bugs me, but it is how it is I guess!
“You can’t always get what you want, but if you sometimes try well you might find, you get what you need – Rolling Stones(Rock Band) – House MD.”
This is the basis of everything, don’t get me wrong, you won’t get 90% of the questions from pathology but 90% of the items will need you to understand the pathology mentioned in that question, and then they may ask the related microbiology.
For pathology, you need to do only one thing, and that is PATHOMA! Yes, Husain Sattar is the King of Pathology, the videos are fantastic, and the book is the “Bible of Pathology.” Every word of that book needs to be understood and memorized.
I am going to repeat this, “Every word of that book needs to be understood and memorized” and also take adequate notes from his videos in the book! I did pathoma two or three times during my second year, and this was my main pathology resource.
The most important thing for USMLE is to connect Physiology with Pathology so before starting a chapter of systemic pathology from Pathoma always revise the associated system from BRS Physiology and you will do good.
Now coming to Goljan, SIR EDWARD GOLJAN is “GOD”, his book Rapid Review Pathology is “The Book” but sadly its not for 2nd year students, it is medicine and not pathology, it has everything from biochemistry to biostats in that book, so if you want to get lost in an island with only one book, don’t choose Dorland’s Medical Dictionary, choose this, and by the time you will be rescued, you will turn into an expert clinician, I guess.
However, I found it too detailed and since it is not provided with any video lectures, doing the whole of Goljan was too difficult for me.
Don’t get me wrong, you use Pathoma, and you score above 240 but you treasure Rapid Review Pathology for Life, I will use it with my internal medicine and STEP 2 CK. Don’t use the whole of Goljan for Pathology but some topics are important which is not covered in pathoma/needs supplementation – they are Types of Shock, Dermatology and Nephritic Syndrome.
Only after completing everything(by this I mean – anatomy, physiology, biochemistry, pharmacology,patho ma, and microbiology) I started with Goljan Audio Lectures which are still available on the net.
I did this to integrate my knowledge, he does an amazing job of integrating subjects and making you think exactly as you should in a UMSLE exam, but don’t think it will cover pathology fully, so do Pathoma, and after finishing all the subjects, you may use this as a supplement.
For college exams and viva, I relied heavily on Pathoma and only consulted Basic Robbins when I saw a 12marks useless question on the “Types of Cirrhosis”(hope you get the sarcasm). I ended up getting honors in college as well as became the senior class assistant pathology.
I have only one thing to say, “Dr. Lionel Raymon”, his way of teaching, his sarcasm, his funny comments, his golden hair, his French accent, everything, this guy is the “Pharma King”, he was with Kaplan during 2010 classroom lectures but sadly now has joined Becker, so you have no choice but to rely on the old video to get him.
The Kaplan book is all you need to do well in any pharma exam anywhere in the world. No need to study or consult Katzung or Tripathi(Indian author) or anything.
Before my college exams for the completion sake, I also did a prep manual, Shanbhag(Indian book), which was concise but then again written in a non-scientific manner, just a stack of facts.
This review will be incomplete without mentioning the name of Dr. Steven Harris who also did an excellent job with general pharmacology and toxicology. In short, Kaplan is enough for any pharm exam anywhere in the world and this helped me to secure the highest marks with honors in pharma in the final review of my college, and I also was selected as the junior class assistant.
Well, this is one of the most hated subjects among the medical students and believe me I am no fan of microbiology. I did microbiology from CMMRS written by Mark Gladwin, and this book is one of the most well-written books according to me!
Every author should ditch the plain facts providing method and start writing novels in more of a storytelling method. This book is just excellent, the pictures, the charts, the mnemonics, one will never forget the nasty buggers they learn from this book.
Doing micro for college was tricky because in India, teachers like to know useless facts like which bugs give positive result to Methyl Red Test and another principle behind such tests which the clinician doesn’t need to know, so for learning all this crap I used Nagoba(Indian book), a prep manual, which took care of those shitty pieces of information.
I did not know about Sketchy then so I couldn’t try it, and I did not use Levinson for microbiology. I supplemented CMMRS with Kaplan video lectures and book when necessary, especially DO VIRUS, PARASITES, and FUNGI from the Kaplan video lectures for microbiology as it is relatively weak in CMMRS. In microbiology, I also ended up getting honors and was selected as the junior class assistant.
I am making this a separate section because it deserves to be independent and the Indian microbiology authors should read foreign authors before writing their books because what they write is absolute bullcrap in the name of Immunology, which makes no sense at all and forces the student to mug up facts.
If you think you can mug up immunology or anything for the USMLE, “you will fail!”, “Understanding is the key,” with all that frustration out of the way now let’s talk about what I did.
I used Kaplan video lectures for immunology where Kim Moscatello tried to make immunology easy through her animations but sadly that did not prove to be enough for me as a beginner, so I supplemented it with the best Immunology book till date, Levinson! If you use Levinson and Kaplan Immunology Lectures together then you will be untouchable, you will finally understand what interleukins are released when and what are the after effects, also in the second chapter of pathoma Sattar provides a concise review of what you need to know. Combine all three, and you know everything there is to know about immunology!
Now let’s come to the most crucial part of 2nd year i.e.
REVISION of first-year topics –
I didn’t pay much attention to Kaplan during my first year, at least I didn’t give my 100% and so I needed to revise the three giants, anatomy, physiology and biochemistry! Without a “strong,””logical” and “scientific” foundation in these three subjects you can never practice evidence-based medicine.
For this, I later realized that High Yield Anatomy (Ronald Dudek) does an excellent job of providing the bigger picture, but I also did Kaplan anatomy because of the radiological images and the high yield points they mention in their videos.
The way they teach is more clinically oriented and doesn’t require you just to mug up the facts. If you are to choose between these two, go for Kaplan. I used High yield later, only during the third year when I didn’t have enough time to revise the whole of Kaplan, and I wanted a concise book, it gave me all that.
Now from going through this forum I learned that High Yield Neuroanatomy is a favorite among the Step takers, but I didn’t find it high yield at all, instead Dr. James White in the Kaplan neuroanatomy section provides a very concise and top yield review with his weird emotionless style of speech, bare with him and take notes, it will help later.
For me, Kaplan was enough for neuroscience, i.e., neuroanatomy and neurophysiology which are taught separately in Indian colleges and usually both the departments fail to interpret and integrate the two properly!
I want to add one thing on this topic that it might be hard for you to understand the pathology part of neuroscience so do Pathoma Neuro section first and then start the neuroanatomy or do neuroanatomy twice like me, before and after Pathoma because its highly volatile, very high yield and tested very often.
Having studied from Kaplan physio during the first year, I didn’t use its lectures for revision but instead used BRS Physiology.
This book is a beast and if you have to choose between Kaplan and BRS go for BRS, its perfect and the writing is scientific unlike Indian authors or even some prominent authors like Ganong(who purposefully write their book in such a manner, so that, it would be difficult for a “novice” student to grasp concepts, clarification: Ganong is a good book but not for beginner students), ideally do BRS Physiology(Linda Costanzo) and the parts you don’t understand use Kaplan videos for them and maybe once in a while use Ganong to look up important facts!
I am repeating this once again from the pathology section of this thread,
“The most important thing for USMLE is to connect Physiology with Pathology so before starting a chapter of systemic pathology from Pathoma always revise the associated system from BRS and you will do good.”
Revised all the video lectures once again.
Now with the second year behind me, five honors, 4 class assistantships, two subject highest, I was still unsure whether to move ahead or not.
People refer to the third year as the most relaxed year ever in the MBBS curriculum with EYE, ENT and Community Medicine(Preventive and Social Medicine). So this was my chance to give STEP 1, and I had to take it by hook or by crook!
The second Year was long and rough, I did my part correctly, and unlike first year I was happy with the knowledge I possessed. Anyone and everyone are almost given honors nowadays, so it doesn’t matter, what matters is your knowledge base, on which you are going to practice medicine for the rest of your life.
This time I had nailed it but was not accustomed to FIRST AID or UWORLD and now was my time to do this. 3rd Year is going to be most detailed because it’s these six months that puts the icing on the cake, and believe me, the difference between 220 and 240 is much less than 240 and 260, so I needed to up my game and here is what I did –
Behavioral Science(Psychiatry) and Biostats –
These subjects are not included in the normal MBBS curriculum so I needed to start from scratch, having no idea how to differentiate schizoid, schizotypal and schizophrenia I started with the Kaplan Behavioral Science videos.
Sir Steven Daugherty is a genius; he makes this tough subject so easy! Browsed the videos and read the books a couple of times and I was done, at least for now. Later this year I would use Uworld Biostats review and Conrad Fischer’s book “100 cases” to solidify my base of Biostats and Ethics respectively.
I completed UWORLD only once with a 76% average in tutor mode and took “heavy” notes, two fat notebooks – 800 pages total – (which I might share soon), many people say do UWORLD twice or thrice maybe, but I did it once, took a six months subscription but only used it for two months, actually 50 days was enough, two or three blocks each day, read the explanations, everything that is written in the comments can be tested on.
Even read the explanations of the ones you got right, we sometimes get questions right for the wrong reasons. Read why the wrong choices are indeed wrong and when will they be considered correct, by this way every question has about 5/6 options, and you are doing 2400 questions, by reading the explanation of every choice you are doing roughly 12000/15000 questions in reality. Take notes, proper notes, write the question and answer in short like.
Newborn is found to have a cervical rib. Transformation of the seventh cervical segment to thoracic identity. Which is true of HOX gene alteration?
– Expression of a HOX gene normally expressed only caudal to C7
Now if you don’t know about HOX(Homeobox genes) search google, but search like this “HOX usmle,” adding Usmle behind the topic you want to eliminates all the useless results and Google provides you the relevant ones only.
I would revise my two notebooks, 2400 questions every now and then, and it took only two days to review them, so now you decide , should you do UWORLD twice or take the required notes at the first go and later revise the entire UWORLD in just two days(two fat notebooks – 800 pages) .
This technique helped me to study the pattern of questions just before the exam, and I revised my journals ( 800 pages total ) 3-4 times, so in other words, I did Uworld 3-4 times, each time within two days.
Hope you get what I mean. Some people add UWORLD notes to first aid but I didn’t do it, and I am glad because by taking proper notes I saved a lot of time later and the questions and all the answers could be more subsequently revised quickly.
FIRST AID –
At first, reading First AID, a mere collection of facts, was boring as hell, so I skimmed through the book, did what I thought was essential and moved on to give NBME 12 and 15, but this later proved to be a mistake, every word of FIRST AID can be tested, when I say “every word” I literally mean “EVERY WORD”, you will be amazed by the detailing of this book.
I did two through passes, first pass – 60 pages each day, took me 10days, I searched the net for facts I didno’t understand, again using the same technique, “Sturge Weber Syndrome usmle” in google and read the first few results and this forum and other related forums helped me to understand the disease, knowing the facts in first aid doesnt help, those facts are written there to remind you of the story about the particular disease that you learned in class, but if you havent heard of “Oncocytoma or Peyronie’s disease”, be active and search google “Peyronie’s disease usmle” and go through the top 5/6 results and form a story in your head about the clinical presentation and dont try to memorise the facts instead because you will forget them eventually.
Took 4 of them online and did the rest offline, NBME 11 to 18 did it all, so that also counts towards the number of questions you do, 200 questions each, I even re-did the online ones offline to check whether I got the questions right by fluke and to revise them and also took notes this time.
The NBME does not provide the answers so, I had to search google for it, but a simple trick like “NBME 18 answers and explanations” will do or explore the specific questions. I will provide my marks in the NBME later.
UWORLD Self Assessment tests are cheap but usually over-predict the score, and it did for me as well, but worth doing as the question in USMLE is difficult like NBMEs, but the length of the questions matches that of the UWORLD.
I peculiarly used them, I bought both USWA 1 and 2 and took them one after the other on the same day. Exactly one week before the exam I wanted to stimulate my “Autonomic Nervous System” with a test like experience, so sat at 8 am and did eight blocks till about 5 pm (real exam is seven blocks, yes one more just in case to test my stamina) continuously one after the other.
Took breaks in between and the experience was good because you get an idea when should you have your caffeine, after two block or three blocks and what is the frequency of you wanting to pee in such a condition :P, Jokes apart the experience was fulfilling and gave me a lot of confidence as well.
X-Factors – (things that help you score above 240)
The X-factors are the things which I did extra, and it provided me with complete knowledge of the disease and extra confidence regarding some topics, (these are often not mentioned in the other USMLE experiences you are going to read in this or some other forum, but I found them useful)
– First Aid Q/A for USMLE Step 1: Highly under-rated, an excellent resource which everyone should use, has 363 cases, you can do a fixed number of cases per day and the facts co-relate with that provided in the First Aid book
– USMLE-Rx : After giving NBME 15(245) I realised that even though I have done UWorld once I didn’t yet master how to answer every question as I did UWORLD in tutor mode, so I had to choose between USMLE Rx and Kaplan Qbank, Rx is better in the sense that it shows the first aid page along with explanation, did 50% of this Qbank, only hard and medium questions, avoided the easy ones, got 82% and it predicted a score of 262, took notes but this time did it in Random mode like the real examination which helped me a lot.
– First Aid for USMLE Step 1: Yes I include this once again on this list because one might get bored of studying first aid at least starting to read from the beginning of the book with biochemistry and biostats, YUCK!!! I did something different, I started from last topic, Respiratory system and moved towards the first page, the book is 600 pages effectively, and I covered it cover to cover twice, skimming it before UWORLD was a mistake, one should remember every page of this book, try to create a photographic memory of every page of this book. If one works hard enough, he/she can finish first aid in 5 days, 120 pages each day, I did this during my second pass.
– 100 cases by Conrad Fischer : “Ethics” is not my cup of tea, but I guess you understand that by reading my way of writing :P, anyway I did this book once, its okay, I didn’t get a star in ethics in the real exam, but I did alright. According to me, Kaplan video lectures along with this book is more than enough.
– Revised Full Pathoma video lectures in two days before the exam, the videos can be watched at 1.7x speed and will take around (20 hours, will post detailed hour scale of each topic below). You don’t want to mix types of necrosis the week before so do this!
– Med bullets: google it, great site, under-rated review material, free of cost, even provides with some UWORLD like questions in the free account, I gave many disciplines a reading like GI, Resp, and Dermatology, no need to buy the premium account! You can use this website to read on facts you don’t understand in First Aid.
– Search Youtube Videos: “Tuberous Sclerosis Usmle” and watch the videos
– Kaplan QBook: I did Biochemistry and Psychiatry form this, doing these topics helps you to build a strong foundation
Resources that I didn’t use –
Here I am going to mention the resources which I know(and most people use it), but I didn’t use them –
- Rapid Review Pathology – Do Selected topics, for rest rely on pathoma
- Najeeb Lectures – Simply too detailed, I didn’t have the time, if you are in the first year go ahead and try them, else don’t waste time
- Kaplan Qbank – didn’t use it because I already did Uworld and wanted to revise First aid along with USMLE Rx
- Kaplan Pathology Book – just don’t!
- Kaplan High Yield Course – it’s not for international students, it is far less detailed and was not for a newbie like me
- Sketchy Pharm and Micro – didn’t know about this, so can’t judge, what I did worked, maybe this will work for you
- Becker Course and Qbank – I only trust the trailer and tested, sadly they now have Robert Dunn, Steven Daugherty, and Lionel Raymon.
- High Yield Neuro/embryology and biostats – too detailed, waste of money, maybe you can look at the CT scans of HY neuro but again for that Kaplan and UWorld should do!
- DIT – didn’t use it, instead used Kaplan, it’s all right, you can go for it
This is my opinion if you like a particular resource stick to it!
Let’s talk about the day and the week before STEP 1 :
The week before, I revised pathoma in two days and Full Uworld notes in the next two days and gave some topics of first aid a brief look, I prepared this list during my second reading of first aid, the things which I usually forget (there is a list by ex-moderator of this forum Rasheed, but I am unique and so are you so make your own!), studied the topics in the list and during the last 2/3 months I started exercising, mainly playing football alone while listening to songs for half an hour each, you need some exercise, one just cannot just sit and study for 10-12 hours a day without any other physical activity.
Also watched many TV shows like House MD(this always gives me hope, maybe there is some science left in medicine, and perhaps we can cure disease by the correct diagnosis rather than just trying to manage the symptoms superficially), played FIFA 16 and GTA 4 and 5, watched some new films but kept away from every distraction possible and kept me almost isolated during the final 6 months, no hanging out, no parties, no 21st century socializing.
Anyway, the day before the exam didn’t go as planned, I thought I would sleep for about 8hours or so and go for the examination next day, but that night I stayed awake all night. It was awful, the next day I guess the ANS reserve kicked in, and I did just fine. Little advice on test day, take enough food and drinks with you, eat your breakfast, I made some tea, and few bars of Snickers(chocolate) with me to keep my blood sugar high and took a lot of breaks (for about 2/3 mins almost after every block.
First, 10/15 questions were practically undoable due to anxiety, but due to the reduction in the number of items (now 40 per block) I had 10/12mins left after each block in which I revised the marked questions from that block. I made five foolish mistakes, straightforward questions, second guessed myself, I will regret this for a few more years. Got about 1-2 WTF questions but they seemed experimental really because no logic seem to apply on them and the last block was of 28 items, all in all, the day went well for someone who didn’t sleep the night before. DONT STUDY THE DAY BEFORE, it messes up your brain! I studied in the morning and evening, and you know the rest!
Uworld – 76% – finished 4months before STEP 1
UsmleRx – 82% (did only medium and hard)
Free sample questions – 94%
NBME 12 – May 02 – 256
NBME 15 – May 27 – 245
NBME 17 – Jun 11 – 262
NBME 18 – Aug 20 – 262
USWA 1 – Aug 31 – 269
USWA 2 – Aug 31 – 264
Share this post, thank you for reading and Good luck people!