USMLE WITH EXCELLENCE SCORE

Tips for passing usmle step 1 with excellence

i just passed usmle step 1 and i want to share my experince with you.

most important Books to read
- Kaplan notes 2000 edition for Micro, Immunology, Physio, Gross Anat, BH, Biochemistry
- BRS Pathology , Ethics and Physician Patient Relation chapters from BRS for BH
- High Yield- NeuroAnatomy
- Goljan Audio for 3 systems. Wanted to do more but couldn’t due to time restraints.
- First Aid (FA)

I would advise you to be thorough with whole of FA. It’s a great book.

Kaplan is great for all. But Behavioral ‘notes’ I found a little lacking. BRS BH is better in some areas. Even the gross anatomy part I found too concise. a lot of the questions I had on step1 from gross anatomy, however few, were outside the material in Kaplan.
BRS Pathology is excellent and provides all the needed material

Biochemistry Kaplan is enough if we consider material but sometimes I feel Lippincott does is better in explaining things. Biochemistry needs a LOT of cramming and so I guess its better to read something that states enough facts and explains well too. So Lippincott, though slightly more time consuming, might be a better option, specially if you are weak at cramming.

Kaplan’s Pharmacology is good but not great.

HY NeuroAnatomy is one of the best rated resource by FA. But i found it the worse. Its a good collection of high yield facts but don't expect it to explain anything and i found that annoying cos neuroanat is not about cramming. Read HY if you have a good background of Neuro or after reading from Kaplan (I don't thin you'll need to see HY after reading Kaplan)

Approach to different Subjects:
Gross Anatomy : One of the low yield subjects. Don’t waste too much time on it. Mostly questions pertain to Nerves of limbs and MAJOR vessels like axillary, Celiac axis, femoral etc. Histology is important specially the cell structure and cell junctions.

NeuroAnatomy:
One of the highest yield subjects. You’ll find a lots of questions on it during your exam. Work hard on it. Pay special attention to:
- Spinal cord tracts
- Diseases of Spinal Cord
- Brain Stem
- Cranial nerves
- Anterior/Posterior/Lateral views and structures of Brain stem

CT/MRIs: The no of radiographs on the exam is continuously increasing so be prepared. Don’t miss any of the following:
1. Axial/Sagittal/Coronal, Inferior views of Brain
2. Carotid Angiogram
3. Transverse section of Thorax, abdomen and spinal cord
I could not find any good source of high yield MRIs. Though you can try to google Brain MRIs and you’ll find quite a few decent ones.

Embryology:
Kaplan’s embryology is incomplete. But I guess if you combine Kaplan’s embryo with FA, it’s a great combination and more than enough for all questions.

Physiology :
It’s a pretty low yield subject in the sense that very few questions would be directly from Physiology . BUT many questions from other subjects will include something that you’ll be able to understand if you know your Physiology basics. So my suggestion is take your first reading of physio very seriously but don’t take too much time cos its very low yield as far as direct questions go. The high yield topics include Hemodynamics, Respiratory and Renal.

Biochemistry :
I was and literally am still scared of this subject cos it needs very good cramming of pathways. Specially the comprehensive pathway that FA has given should be on your tips. Specially where two pathways join each other. Don’t miss even a single reaction from the vitamins, they are too high yield. The explanations of UW I found very good for Biochem.

Genetics:
Very high yield and high scoring at the same time. Kaplan’s is good enough and Lippincott’s is great too. Be prepared with questions that’ll rack your brains based on your understanding of genetics. Pedigree analysis for simple disorders is also important.

Microbiology :
Gross micro is toooo low yield. Don’t waste your time on it. I wasted 15 precious days intensively studying the whole micro. I think the material given in FA is more than enough. The only part you should know is to identify the organism based on Gram staining, morphology (cocci/rods/commas, clusters/chains), motility etc which can be easily accomplished using FA charts etc. The chapter on comparative Microbiology in Kaplan is good in this regard but not necessary.

Immunology:
VERY high yield. You should know all that is given in Kaplan and FA. Don’t miss anything from Immuno because you’ll surely have a large number of questions on it. Specially the list of Interleukins given in FA is indispensable.

Pathology :
nearly 50% questions on Step1 are directly or indirectly from Pathology . I just did BRS and I think it was more than accepted. Unfortunately I couldn’t complete even BRS.. But then I think USMLE patho is something that can be substituted by your knowledge of clinical subjects. Becos rather than being hardcore Pathology , its more of clinical patho based on etiology, symptoms, diagnosis, variants etc. I didn’t even care to revise most of patho cos the important points that need revision are beautifully given in FA. The only chapter I’ll specially recommend to be thorough with is Renal system.

Goljan audio is just great, though I could just listen to 25% of it. But if time allows do listen to Goljan audio. He’ll give you fundas that you’ll probably never grasp otherwise. His sheer wit and simplicity makes him arguably the best teacher I’ve come across.

Pharmacology :
High yield subject that needs some decent cramming. Specially important are specific adverse reactions and major interactions of important drugs. Don’t start memorising every drug you come across. Just the major drugs’ interactions. And focus on class rather than individual agents.

UW has good questions and explanations on it. There were a couple of questions on newer drugs like Fenoldopam but I guess such questions are usually simple and they give enough hints to reach an answer.

Behavioral Sciences:
Ironically, this subject was a bane for me and it proved to be my undoing in my actual exam too. I performed worse on it. I did Kaplan mainly but the questions, specifically from ethics and physician pt relations are so ambiguous and confusing that no amount of study helped me.

I think BRS BH is much better than Kaplan in most aspects. Read and practice very carefully the questions on ethics. UW’s ethics questions were good but I guess not enough for me..

Question Banks:
- I did not do Qbook
- I just did the questions behind every chapter of Kaplan except patho.
- I used UsmleWorld (UW) and found it great. The questions on actual exam were of similar level as that of UW though the pattern was quite different. UW questions mostly test your knowledge of facts while I felt the actual exam tested more of your understanding and of those facts.
- Specially, the pharmac, Biochemistry and BH questions of UW were pretty good.
- It is said that add 30 to your cumulative UW score to get actual Step1 score. I got a cumulative of 69% on UW so I guess the formula is close. But for that use only random/unused questions mode.
- I continuously altered my line of preps based on my performance on UW. I read the explanations very carefully that’s why it took me a long time and I could do only 1300 questions out of available 1800+
- Kaplan Qbank is also good but I did not use it.
- But finally the major factor that I used to make my preps more focused was NBME’s self assessment test (CBSSA). I took them twice, once after first read (around 28 days before exam). 2nd time about 5 days before actual exam. I specifically took NBMEs very seriously cos they’re said to be the best predictors of your performance on actual exam. I'm a strong supporter of using NBME's tests during your preps.

USMLE CD: It has relatively simpler questions but read them carefully because the actual questions will be EXACTLY ON THE LINES of those, just a more tougher though. Many people get 2-3 questions on actual exam from the CD itself so don't forget to do it. I scored 44-42-45 on it.

i hope this tips will help you all

please share your experience. thank you

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My Step 1 Journey
This is, in short, my little journey with USMLE step 1. First of all, let me tell you about myself a bit briefly, I was an average student in the College of Medicine, University of Baghdad. I was not one of those studious people, however, I was not one of those really at the bottom.


My decision to come to USA was rather a condition, not a decision. When I first started preparing for Step 1, my ultimate goal was 90-plus. But gradually, along the preparation process, my limit was going up, till the point where less than a 99 would have been considered a failure for me.

Books,
Kaplan books only, I did not see anything apart from them, in my opinion, they are more than what is needed for the test, but that is still OK, as the test has no limits and you will always need extra. I did not see the 1st Aid and nothing else at all.

First-time study( normally 3.5 - 6.5 months ),
Preferred order ( Physiology, Biochemistry, Anatomy, Behavioral, Immunology & Microbiology, Pharmacology, and Finally Pathology).
Way of Study ( I used to watch a Kaplan video in the evening, starting from 7, for 3 to 4 hours, depending on how patient you are. Then I studied what I watched next morning till the evening, then another video, then again....

Revision ( 3-4 Months ),
Here, a lot of possible options, you could start doing questions ( I started with Kaplan's Qbank), one block ( timed and mixed ) early in the morning, then after the block I studied the books again, in the same order mentioned above, then in the evening, I revised the block I already solved, at the beginning, each block took me 2 days to revise, until I revised 4 books, then I was going a block each day.
Some other option is that you revise the books only, in 6 weeks then start doing Qs only till the test.

Questions, I started with Kaplan's Q bank, then I shifted to USMLEworld, I did 90% of the Qbank and only 28% of the USMLEworld. But finishing both of them all is better.

Score, I got a 99 (242), as I said before, I did not believe in myself scoring it at the beginning, however, my expectations were going higher up over the time.

Recommendations,

1st study is the most important, spend as much time as possible and try to cover each book very well before you move to the another, remember, by the time of revision, you are too exhausted to memorize something new. So why not doing it at the beginning?
Be consistent, try to avoid long time interruptions.
I am a bit slow, so the above times are about me, some can do it way shorter, but longer, I do not think it is healthy, unless there are a lot of stuff in your life to deal with.
As the test is closing in, start preparing physically for it, do a simulated test (7-block) at least once, at least 5 days before the test.
If you are taking an NBME, which I prefer, take one or two or both, but not the others, as those two give the most accurate estimate.
You can do it, and it is a long process, with many ups and downs, just believe in yourself.

All the best in following your dreams...

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