Finally, a relief: USMLE Step 1 preparation and thoughts

USMLE scores are released every Wednesday, and mine just got in. I was relieved that my score was in the predicted range of my practice tests and that my prep had not gone in vain. This post will outline my preparation strategy, advice, and my scores leading up the real one.

Firstly, my philosophy in preparing for any exam – USMLE, block exam, NBME shelf – is to leave no stone unturned. As a physician, I want to know what’s going on with my patients without doubt. Hence, I like to go through all the material, know all the material, and be able to explain all the material. If I can do that, I’m confident in my knowledge. With that mindset, I approached basic sciences, so I had a solid foundation of all the coursework I had completed. Without this, prepping for the USMLE Step 1 is pointless.

  • My first wisdom is to solidify that knowledge base of basic science. There are many ways to do this; this is the point of taking a review course.
    • I started my preparation at the start of my 5th semester (early September 2014) rather than waiting until my courses finished
    • It was strenuous to juggle classes, exams, and preparation, but I persevered because I wanted to do the best that I personally could
    • To solidify my knowledge base, I reviewed slides from my courses and used:
      • Doctors in Training
      • Kaplan Physiology and Pharmacology
      • Pathoma (note that I think Pathoma is phenomenal after reading big Robbins fully)
  • My second wisdom is to do questions, even if you don’t think you’re capable. I started the Kaplan q-bank doing 46 questions a day when I started my prep. My scores were initially abysmal, but slowly they climbed. Every 2 weeks was a solid 5-10% increase until I hit a fluctuating plateau.
    • About halfway through 5th semester I finished Kaplan q-bank and switched to the USMLE-Rx q-bank. By December I was done with that one. I did 2 blocks a day until about 3 weeks before my exit exam (NBME Basic Science Shelf), where I had full days of dedicated studying. I then did 3 blocks a day.
    • After the exit exam and a few festivities on the island, I started studying again at home with USMLE World in December.
    • I had honed testing to an art form; my timing, my pace, my breaks, and, most critically, my review methods at this point were all efficient. I made index cards on questions and concepts I missed or got right by good guessing. I reviewed these cards. I got up for 5 minutes for a break every time. I had a pre-exam fact sheet memorized. Everything was done for a reason.
  • My third, and final, wisdom is to build up stamina. Starting when I began studying, every Saturday (with the exception of weekends with block exams), I forced myself to take 4 hour-long exam simulations.
    • I was unable to focus properly for the first one and was mentally and physically drained. After the second and third, I was able to get through all 4 hours, but barely. Eventually I could get through the exam with ease. By the time the exit came around, I was able to not only take 4 blocks, but review all 4 blocks in the same day.
    • When I returned home, I knew I wanted to double the time of focus, so I began training in the same way. All in all, there were 2 days where I took 7 hour practice exams, and one draining day where I took an 8 hour exam (NBME 16 + UWSA 2) – about 3 days before the real exam on February 9, 2015

So, what material did I get through? The list below is the order of material I went through, and the number of questions is approximate, with my performance given:

  • Kaplan q-bank and miscellanea: 2500 questions – 75%
  • USMLE-Rx qbank: 2300 questions – 81%
  • BRS Physiology, Pharmacology, Biochemistry, Pathology: 800 questions
  • Lippincott’s Pathology Q&A: 200 questions (not completed)
  • NBME 15 : 200 questions – 251 predicted
  • NBME Pathology Shelf: 200 questions – 99th percentile
  • NBME Basic Science Shelf: 200 questions – 96th percentile – 260+ predicted
  • Free questions on USMLE.org: 150 questions (don’t remember % correct)
  • USMLE World: 2300 questions – 80%
  • NBME 13: 200 questions – 260 predicted
  • NBME 7: 200 questions – 254 predicted
  • NBME 11: 200 questions – 249 predicted
  • NBME 12: 200 questions – 262 predicted
  • USMLE World Self Assessment 1: 184 questions – 265 predicted
  • NBME 16: 200 questions – 260 predicted
  • USMLE World Self Assessment 2: 184 questions – 265 predicted
  • ——————
  • Total practice questions done questions: 10,000+; real score 259

Overall, the real exam felt like just another practice test. There were some bizarre questions that no amount of preparation can ready you for, and there were some nit-picky level of detail questions, but overall, I was satisfied with it. I didn’t walk out of the examination center elated, but I  wasn’t discouraged or depressed either. I knew it was done, and, now that I have my score, I can say it was worth going through all the extra material.

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