Step 1 (first attempt), my experience

Medicoman · September 7, 2018, 5:38am

Hi everybody! My name is Nicolas, I graduated last year in Argentina and spent it studying for the step 1. I got my score a couple of weeks ago and I wanted to share the methods I used, basically because reading other’s people advice and experiences was tremendously helpful for my preparation and I would like to do the same for others.

First of all, I think that it’s important to know that we might be very different people with different thoughts, styles, weaknesses, strengths, prejudices, academic preparation, time available and even different IQs, but there are some general concepts and “rules” that I consider that can be useful for everyone trying to get a high score in step 1. These “keys” are widely spread through the internet in many sites and forums, including this one, of course, but I will try to simplify and summarize them here to make things easier for those aiming to this tough but perfectly possible target.

Before telling which set of books and other materials I did use, I’d like to highlight that our goal is not to use a lot of different materials or to end up reading some books over and over some X number of times (eg: First Aid) but to get the highest mark as possible in the real exam, and we can achieve that in more than one single way. This is important to know to avoid getting frustrated halfway when we can’t watch all Kaplan videos, read First Aid 4 times or repeat the whole USMLE World bank. I personally followed the ZumZum Method (the single best study plan that I found most suited for me) and couldn’t keep up with it, but it was the base from which I ended up making my own plan, with some additional improvisation, for what I will be always grateful with Dr. ZumZum.

Next, I will summarize in a list the best pieces of advice I found over the internet and some others that I could come up with during the study process:

Where do we come from?

Firstly, it is a good idea to take an initial diagnostic test (it could be Kaplan’s Diagnostic Test, which comes with the 12 months subscription, or USMLE World’s Self Assesment 1 and/or 2). If you can avoid getting frustrated by an almost certain low score, it can give you really useful information about where you are starting to study from and maybe which specific areas deserve the most of your attention. I personally didn’t do this, but I would definitely do it had I prepare this exam again. This way you can more effectively evaluate your progress during the process and predict more accurately when you are going to be ready to take the exam.

Where are we going?

This may be the most important step to make your study plan. You have to decide which score you pretend to get, or at least the minimum score so all your effort makes sense, and how much time you can and want to invest for that quest. Knowing which specialty you are interested in can be helpful to determine how high your step 1 score should be to avoid having trouble getting interviews. Although some specialties don’t put much weight in step 1 score (eg: psychiatry, the one I’m looking forward to ), a high step 1 passing score can’t hurt anybody!

Don’t underestimate the importance of clearly setting your target score and study time, in the middle of the study jungle it’s pretty easy to get confused and lose perspective. In my case I ended up taking the exam 2 months later than I had planned, with its subsequent higher risk of burnout, because I didn’t have all the relevant information from the beginning. So, I think that the moral is that you better have everything you can analized and decided from the beginning but don’t desperate if you already started studying and have to change something in the way. It’s true that it’s usually better to stick to whatever plan you initially made, but I recommend to be flexible enough to make some changes in your strategy if you have a strong insight about how it can improve your final outcome.

Make a list of things to remember in the midway

This is a really tough road and it’s important to always keep in mind certain “rules”. While you are still fresh it’s a good idea to make a list of things that you want to remember when you might be tired and confused in the middle of the study schedule. You can find lots of these key concepts at the beginning of many books (Eg: First Aid, Kaplan QBank, etc.), but I will mention some that were really important to me:

This is a perfectly possible project. It is also perfectly normal to feel exhausted and pessimistic halfway, learn to question your own feelings and pessimistic thoughts and think that what is happening to you also happened to many people who finally got a high score. I cannot tell you how many times I felt that I was bound to failure.
Remember that nothing’s more important than the final outcome, it’s perfectly fine to do things differently to the advice you get (even this one) as long as you can still get to your target that way. The most objective feedback you can get about it are your USMLE World Qbank score and the NBME forms; getting a high score in them is the best way to know that what you are doing is right.
Don’t delay doing question banks, it is strongly emphasized everywhere that all good study plans require making lots of questions in the random timed fashion. Start doing this ASAP, if I had to take this exam again I would start doing UW much earlier in the schedule than I did. I know many cases of people than despite having read tons of books, delaying the practice with question banks was quite detrimental to their performance. On the day of the exam you should not be worried at all about the format or type of questions in the examination. Doing practice questions should be an essential part of your whole study plan.
One of the most important things: ACTIVE LEARNING. Try to avoid passive reading or semi-effective study, your time is really important and you should also wisely spend it in having fun and healthy activities. Once you have decided to sit and study, try to keep in mind that everything ends up with a set of multiple choice questions, so try to conceptualize every possible piece of information that way. Paraphrasing, making diagrams and doing many multiple choice questions are some of the best ways towards active learning.

Choose materials

Fortunately, there are many excellent review books and other materials and you can find out which are the most popular in the internet. Try to think wisely what type of learner you are and which set of materials you can get the most from. Next there’s a list of what I decided to use and what I did finally use and in the order that I did it:

BOOKS

-First Aid 2013: I would read every section after finishing it in the other books and did 1 reread just before the exam.

-Kaplan USMLE Step 1 Qbook: After each discipline I would do it’s respective questions from this book (didn’t like it too much).

-Kaplan Lecture Notes 2010: I read Behavioral Sciences, Biochemistry, Histology Section of the Anatomy book, Microbiology and Immunology and Pharmacology.

-Kaplan lecture videos 2010: Could only watch Behavioral Sciences, Biochemistry, Histology and some spared Physiology videos when I needed it to better understand a specific topic.

-High Yield collection (4° ed): I read the Gross Anatomy, Neuroanatomy and Embryology books. I also bought the Molecular Biology one but didn’t read it.

-BRS Physiology: I really liked this book.

-Rapid Review Pathology: A must for many people, I liked it.

-Netter Anatomy Atlas: Just to compliment my anatomy study alongside with my personal skull

-USMLE Medical Ethics 3° ed (By Conrad Fischer): I read this book a couple of weeks before the exam and loved it, but unfortunately I don’t remember answering any ethics question in the real exam using what I learnt from it.

-Bought Clinical Microbiology Made Ridiculously Simple but couldn’t read it. Please before buying a book think carefully whether you are gonna read it, I felt pretty stupid doing this (although I was forced to buy it with too much anticipation in order to get someone bring them from USA). Having weaknesses with a certain subject (as in my case with microbiology) doesn’t necessarily mean that you must read many books of that subject, you could spent more time studying it or do more of its questions and that could be enough to compensate.

QUESTION BANKS

-Kaplan Qbank: I bought the 12 months subscription to use it between subjects, just as the ZumZum Method recommends. In the end, I did 86% of the questions with a 75% of correct answers.

-USMLE World QBank: The single best question bank, specially for the last weeks of study. I used it as my main source of study for the last 2 months annotating everything I wanted to learn in my First Aid. I did the 100% of the Qs getting a 79% of overall correct Qs, and then redid the wrongly answered ones, having 2 weeks left to review the First Aid and take some NBMEs.

-NBME: I did NBME Forms 15 and 7, getting a prediction of 250 and 252, 2 weeks before the exam.***

-USMLE World Self Assessment (UWSA) 1 and 2: I took them 1 week before the exam and got a prediction of 263 and 265+.

-USMLE Free 150 Questions: Did it 1 week ago and got 94%, which would mean a prediction of 268 +/- 11.

*** I read that NBME Forms may underpredict “conceptual learners” as it is more memoristic than the real exam, and that UWSA and USMLE Free 150 Qs usually overpredict scores. Both things happened with me as I did around 10 points better than NBME prediction and a some points lower than UWSA. Anyway, with some margin of error they all showed to be acceptably accurate. In conclusion, make these tests the final judge of how well prepared you are to take the test!

OTHER RESOURCES

-There are many, almost infinite, resources you can use to compliment your study plan and you can find them all over the internet, the key is to detect which are best suited for you and make your own best plan.

Once definitive, stick to your plan!

Even though there’s always place for some modifications, it’s really important that once you decided how much time and how you are going to study, you strongly stick to that. Besides losing time, the greatest risk of getting lost in your own plan is that things stop to make sense and you get in a downward spiral towards lowering your expectations or even giving up. There are lots of places in the internet that can help you to keep things in perspective and have a realistic outlook. Just try to stay away from pessimistic or fanatic concepts and remember that your own path towards success is as valuable as any other, no matter how many difficulties you may have.

Next days I will try to complete and add more things to this post, I hope that someone find this useful and please comment and ask whatever you want to! Good start for everyone in this new year and best of wishes in this exciting fight!