Friday, December 19, 2014

My USMLE Step 1 testimonial

I recently took the USMLE Step 1 and got a good score by the Grace of God. A lot of people have been asking me about my preparation so I thought I should write a blogpost about it to help others.

What I used (I'll explain the brackets later):
2. First Aid
3. Pathoma (redundant)
4. Kaplan review books (redundant)

Total time: 7 months (effectively 5 months)

Kaplan period: (~2 months)
I started off in April with a late November plan to take the exam. Initially I sat down with the Kaplan review books for Step 1 because that's what everybody tells you to do. I completed Biochemistry and Anatomy in about a month each. Halfway through Physiology, I realized I was chewing more than I could swallow. I made the decision to abandon Kaplans altogether. These 2 months I regretted.

UWORLD: (~3 months)
I then started solving UWORLD questions for the sole purpose of learning. It was really tough for me since I usually got 40-50% right per block. But I didn't fret. I spent a lot of time on the explanations and studied UWORLD as my primary knowledge base. Once completed, I revised them completely a second time briefly (and a third time after my first FA read). Here I would like to mention that while UWORLD is a very good learning tool, I would not recommend it as an assessment tool. It is much harder than the actual exam and tends to ask questions in a very different way.

First Aid: (2 months till exam)
First Aid is the best prep you can get. Almost all of the exam is from First Aid. At first it may look like a strange jumbled up piece of crap but with repetition, you come to realize its greatness. It tells you everything you should know for the exam.The biochemistry part might be a little hard to fathom if your old knowledge is dusty. That's the only part where studying the biochem Kaplan felt relevant: to ease the transition to First Aid. I studied Pathoma for the system part of FA too but felt it was redundant and left it as well. The first read of First Aid is very important. You need to make sure you understand each and everything written there, even if you don't remember it later. I spent an average of one day per chapter for my first read, just making sure I understood everything. The second read should be to identify your weak points and stuff you tend to forget. With each subsequent read, you'd realize the problematic stuff gets smaller and smaller and you feel more comfortable with the book.

NBME's are the best representatives of the actual exam. I took my first NBME 35 days out (NBME 11) after feeling a little confident with FA and got a 234. It was okay but I believed I could score higher. Still, I booked 27th November for the exam, being confident that I'd make it better in that time. 5 days out, I took NBME 16 and got 237. I was devastated. I felt like running around circles. I really thought I was going to improve but a score of 237 felt like I wasn't doing enough. My performance charts for both NBME's are shown. Then I had a Eurika moment when I was going through the explanations of questions. I realized that the exam is only as difficult as you make it to be. There was a question in NBME 16 that sounded like one of those that you feel like you have no idea about. And when I found the right answer, I realized that it demanded the simplest possible explanation for it. Bearing this in mind (and the thought that 240ish wasn't a bad score either), I gathered my confidence and went for the exam.

Exam day:
Naturally, I was extremely anxious but confident too. I took a lot of chocolates with me and some Panadol Extra tablets. I did the first two blocks in one go because I was feeling very confident. I did each question as quickly as possible while marking the doubtful/ difficult ones. Almost everybody I knew had problems with their timing and this is the best strategy to deal with it. With this strategy I always had 6-10 minutes surplus after the first go in each block. NEVER spend any time trying to confirm the answer in the first go, do it in the surplus time. My first block was really tough but the second one was okay. I took a 5-7 minutes break and did two more blocks. Then two more and then the final one. Briefly, blocks 1, 6 and 7 felt really tough and I had to mark 13-16 questions per block. Blocks 2, 3, 4 and 5 felt very easy and I marked 6-7 questions per block. After the exam I wasn't sure how I performed but I was confident I wouldn't get a bad score.

General advice:
1. Confidence is key. You should be confident that you know everything and are ready for the exam. Keep a date in your mind and stick with it. I had planned for the last week of November from Day 1. I got the triad of October-November-December but never once thought of delaying the exam.
2. Don't listen to people too much, believe in yourself. When I decided to go ahead with my last score of 237, a lot of people tried to convince me to delay my exam. Some even joked that I should leave the exam half-completed if it felt too difficult so I could reappear.
3. Never be afraid of a question. Always tell yourself that you know the idea behind the question and it's only a matter of getting there. You should never feel like "Oh my God, I never studied this/ forgot this". Most of the times, you can easily get the right answer in such questions just by simplifying it.
4. Try reading the last line of each question before reading the full question. It tells you what to look for before reading the question. This is very very helpful.
5. Keep yourself positive no matter what i.e. don't think you can't do anything but study. In the last month leading to the exam, I took a week off to study for FCPS Part I and went out with friends on several occasions including going to the cinema once.
6. People had scared me that anatomy is really tough on the exam and I should have studied a separate book for that. I did not feel so. While there were really tough scenarios, the questions were really simple. Most of it I knew from my knowledge of first year anatomy. You may study a separate book for it if you like but I wouldn't recommend it.

Eventual score and conclusion:

My actual score was 251 which I had a lot of trouble believing. It was definitely much higher than I expected. It shows that while NBME's are an essential tool, you should never let them keep you down. That being said, I would also like to emphasize that what's true for me, might not be true for you. Feel free to post any queries, I'd be happy to reply.

Best of luck!