238/99 my experience

Background:
British IMG graduated July 2010. Let me start off by saying I was not the most brilliant medical student, was in 3rd/4th quartile in most of med school and literally just about floated through med school. I went into Step 1 doubting my ability to score a 99 and it scared the pants off me because EVERYONE seemed to be getting 99 and scoring in the 250's. It was like you had to sit at home and cry if you got a 98.

I know 238 is not a brilliant score for this forum but you know I'm not complaining! I just want to remind people that you don't have to be an amazing genius to do well in Step 1 and it does boil down to hard work. I started off thinking I'd struggle to pass and ended up here so anyone can!

Started studying mid August 2010, took the exam January 20th 2011 (last Thursday)! Total prep time: 4-5 months

- NBME 1 (after watching Kaplan videos): 185
- NBME 6 (late Oct): 197
- NBME 7 (Dec 31st): 240
- UWSA 2 (Dec 31st): 252
- NBME 3 (two weeks to go): 231
- USMLE Rx simulation (1 week to go): 266

Final score: 238/99. Yes I did score within two marks off my NBME 7. Sadly my UWSA2 and Rx were waay off.

Materials used:

Pathology: BRS pathology, RR pathology, Kaplan Pathology
I would recommend reading BRS path once then listening to Goljan audio along with the RR pathology. I tried to read RR pathology but found the format difficult to deal with although I loved Goljan audio. Kaplan pathology was okay for pictures and I mainly used it while attending live lectures where I had Dr. Barone as a lecturer and he was pretty awesome.

Microbiology: First Aid, Clinical Microbiology made Ridiculously Simple (better than Kaplan micro)
Wasted a whole week watching Kaplan microbiology videos which were really not necessary. If I could start over, I would read CMMRS and supplement with First Aid.

Physiology: BRS physiology (highly recommend this), Kaplan Physiology
Kaplan physiology along with the videos were pretty decent. I only 'discovered' BRS physiology a month before my exam and although everyone says not to read new material so close to the exam, I gave it a quick read and really liked it. I think if you know BRS physiology cold it's sufficient for the exam.

Biochemistry: Kaplan biochemistry, First Aid
I watched the videos but didn't know the material really well until I attended the Live Lectures and had Dr. Hansen as a lecturer. She is pretty amazing and I went from Biochemisty being my weakest subject to one of my strongest. First Aid has a few conditions that weren't covered in the Kaplan textbook which is why I'm mentioning it.

Pharmacology: First Aid, Kaplan
I had a pretty good pharmacology lecturer during Live Lectures as well. I annotated Kaplan pharm into First Aid and I think that was enough.

Behavioral Sciences: Kaplan, First Aid
I read the Kaplan behavioral sciences book once and didn't touch it again. Reviewed First Aid before my exam. I had Dr. Fadem (she writes the high yield behavioral book) for live lectures and I've heard good things about her book but I didn't end up using it. My med school was pretty keen on Behavioral so I felt like I had a good starting foundation and it was my strongest subject in all my NBMEs.

Anatomy: Kaplan anatomy, HY neuroanatomy, First Aid
Anatomy was my weakest subject in all NBMEs and the actual exam. I kinda wish I had given more time to it. I felt the Kaplan anatomy book was over-detailed so I read it once but didn't really go back to it. I didn't read all of HY neuroanatomy just the bits on brainstem and spinal cord and some pictures. My neuroanatomy was pretty solid towards the end because I spent some time going through the pathways, pictures etc but I still really sucked at overall anatomy. I did get a lot of random anatomy questions on my exam (not just brachial plexus!) so yeah contrary to what you may have heard First Aid is NOT enough for anatomy.

Question Banks:

Finished U World once and then did incorrect questions again. The No 1 thing I would recommend is to annotate into First Aid concepts from UWorld as you go along. If 50 questions sounds too much, start off by doing 10-20 questions a day just make sure you annotate. The difficult questions in the actual exam are UWorld style so this is really helpful. I managed to annotate maybe 40-50% of UWorld into First Aid as I was pretty lazy in the beginning. My average was 56% first round and 80's towards end of second round.

I also did Kaplan Qbank, finished around 60%. I think I was on 65-70% towards the end. I don't know if I would do the Kaplan Qbank if I had to start over, I didn't find it extremely useful.

USMLE Rx. Finished 30%. Averaged 77%
I bought this about two weeks before my exam because I kinda run out of questions to review on UWorld and wanted to consolidate First Aid. I really liked it. It makes you notice the small details you skimmed over in First Aid. It was also good for doing a full 8 hour simulation test a week before the exam. It predicted me 266 though but I think it has a +/- 20 error margin. I almost prefer this as a second Qbank over Kaplan but Kaplan seems to be more popular and my scores haven't come out so maybe I'm wrong.

August to October: I started off watching Kaplan videos for Biochemistry, Microbiology and Physiology. My studying during the first few months was kinda on-off and I maybe did 4-5 hours a day. I found the videos good but a little slow and most of the time I was nodding off. I also listened to Goljan audio once (using RR pathology along with it) during this time but again it was a bit slow for me and I didn't really appreciate Goljan at this point

October to first week of December: Kaplan 6 week live lecture course. Lectures were amazing for pathology (Barone!), pharmacology and biochem. Others were decent but not anything to be over the moon about. The only downside of the lectures was that it didn't give me a lot of time to study in the evenings and I was lucky if I finished a block of UWorld questions at the end of each day. I guess it depends on how focused you can be. I also spent some of the time there socializing ( yes you do meet some decent people on the course) so I wasn't really pushing myself 100%.

December to exam: Crunch time. Ended up studying maybe 12 hours a day minimum, barely left the house etc. I was never an amazing student at med school but once I made a timetable and realized how much I needed to get through I just sucked it up and starting working my a** off. My score bumped up from 197 to 240-250 after three weeks of intense studying. I didn't really want to move my Jan 20th exam date because I had holiday plans end of January.

Things that really worked for me:

1. I went through First Aid using the DIT videos. This really forced me to buckle down and get through First Aid instead of just skimming over it. You may not need it if you are a focused person but if you are slightly attnetion deficit like I am, this really helps as Dr Jenkins kinda drills all the facts into your head. I watched them 1.7x times speed.

2. Listening to Goljan pathology again. I appreciated Goljan so much more second time round after I had a better pathology foundation. I also listened to this at 1.7x times speed as he was going too slow on normal speed.

3. Making connections. Annotate, annotate, annotate. If you read about a disease in First Aid, that is maybe mentioned in another section, make the connection and write it down. The actual exam is all about concepts and making connections. E.g. Paget's disease may cause high output cardiac failure (mentioned in the musk section of First Aid). Write this down in the cardiology section also. Add to it what kind of physiological values you would expect in high output cardiac failure. So this way you end up connecting musk +cardiac path+ cardiac physiology.

Actual exam:
More tiring than any of the 8 hour simulations I took. Maybe it's the stress bubbling away underneath. Make sure to get a good nights sleep before I know a lot of people who couldn't sleep the night prior and this really affected their performance. Avoid caffeine after midday the day before, go out for a movie or dinner with a friend.

I got to the Prometric Center around 7:15 am and I think ended up starting my exam at 7:30 am or something. Did the first two blocks back to back, took a break after 3rd and 4th, did blocks 5 and 6 back to back, took another break then did my last block. I had a massive headache during my 4th block which I think was due to caffeine withdrawal so I took a break after that and had my lunch and some coffee.

Question-wise: some of it was really really easy. There were definitely quite a few 'free' questions where you were kinda like 'come on are you serious?'
Then there were the mid-range questions where you kinda felt good about yourself because you were like 'this would be difficult if I hadn't studied my ass off but I did'.
Then there were the horrible ones. Most questions I could narrow down to two choices then I'd be stuck between them for ages. Some questions were so bizarre that I felt like shouting at my computer screen. There were questions I felt like even if I had spent another year preparing for Step1 I wouldn't have known the answer.

Time wise I was surprised by how I didn't have 20 minutes extra like I normally did for my practice tests. I had three minutes left after going through my marked questions in Block 1 ( I did spend a considerable amount of time going back and forth between choices) so I cranked it up and sped up a bit for the blocks after. But yeah as I said I'm normally a fast test-taker and I didn't have lots of extra time in the real thing.

Looking back, I felt really bad coming out of the exam and was worried I'd score a 220 or worst..fail. I didn't come out thinking I'd aced it and I know there were a lot of holes in my anatomy knowledge that pulled my score down in the exam. I have always disliked anatomy, my school never taught it well and I tried to avoid it as much as possible in my revision. My advice would be...if you truly suck at one subject do more of it! If you hate anatomy do more of it! If you hate biochem do more of it! (Biochem was actually my worst subject at the start of studying and I ended up getting a higher performance star thing on the actual exam). I think for me personally I would have done a lot better if I'd studied more anatomy instead of being lazy and telling myself things like "they don't ask that much detailed anatomy in Step 1". Whatever your Achilles heel is it WILL kill you in your exam.

I hope that was useful for you guys.