Name: Abdelrahman Abusaif Step 1 Score: 265 Exam Date: April 22, 2019 Background: Step 2 CK already done (got 261), YOG 2016 (end of Emtyaz at Suez Canal University, Egypt). Preparation Time: 9 months (Total 12 months minus 3 months gap in the middle). Daily Study Hours: 6 hours (3-4 hours in the last 3 months).
Assessments:
I have highlighted in green the self-assessments generally considered the most predictive. I also highlighted in blue the new NBMEs which were released just 1 month prior to my exam; their predictive value is still to be determined. UWorld Qbank 90% Throughout my preparation period UWSA1 266 2 months out NBME 16 259 6 weeks out NBME 18 255 4 weeks out NBME 20 259 3 weeks out NBME 21 263 2 weeks out NBME 22 267 12 days out NBME 19 6 mistakes 11 days out NBME 17 5 mistakes 10 days out NBME 15 9 mistakes 9 days out NBME 13 10 mistakes 8 days out UWSA 2 266 7 days out Free 120 Q’s 91% 1-3 days out
Resources by approximate time spent on each resource: 1) Anki Flashcards: at least 40% of my preparation time went into Anki reviews & new cards. The total number of Anki cards I’ve learned throughout my preparation was more than 10,000 cards. However, since I was mostly using pre-made decks, a large portion of these cards were very basic medical facts that I already knew. My Anki stats show that I’ve done about 75,000 reviews in 550 hours over the course of my preparation. 2) UWorld Qbank: another 30% of my preparation time went into doing UWorld blocks & reviewing my mistakes & near-misses through Anki. I did it only once & didn’t redo my incorrect questions. Answering questions is not the main time consumer here; what took the
most time was actually studying the explanations and, to a much larger extent, taking notes of new facts in these explanations & converting them to question-answer format in Anki. 3) Sketchy Videos: all of micro & pharma (both combined 40 hours) + half of pathology (watched about 25 hours of SketchyPath). I did them only once & didn’t have time to repeat the videos or revise the pdf but I reviewed my Sketchy-based Pepper Anki cards semiregularly. 4) Kaplan Videos: Kaplan 2014 Classroom Biochemistry & Genetics Videos: 47 Hours Total = 40 Hours without the 10-mins breaks in the videos (further reduced to 30 Hours if watched on 1.5x speed). [simultaneosly with Kaplan Bio book] Kaplan 2015 Classroom Anatomy, Embryology & Neuroscience Videos: 33 Hours Total = 29 Hours without the 10-mins breaks in the videos (further reduced to 20 Hours if watched on 1.5x speed). [useless] 5) Other Videos: Pathoma 1st 8 chapters: 15 Hours. B&B in select topics. 6) Self-assessments: as above. Each NMBE takes about 5 hours, then another 1-2 hours to revise & to search for explanations for the wrong questions & the questions I got by luck or was unsure about; that makes for a total 6-7 hours per NBME over 1-2 days. UWSA takes a bit longer since there are lengthy explanations filled with new facts & concepts. Therefore, the above self-assessments may have taken 80-90 hours.
Timeline:
(A) Subjectwise 1st Run (7.5 months): In every subject, I followed the same sequence: I watched the relevant videos while adding relevant new Anki cards every day to my master deck & doing them, then I did UWorld for that particular subject. After that, I moved to the next subject. I didn’t use books except for Kaplan 2018 Bio Book. I skimmed through First Aid in some subjects (Bio, Micro, Anatomy, Physiology) but I didn’t really study it so I didn’t include it in the table below. Subject Videos Books Anki Deck UWorld Duration *** Biochemistry Kaplan 2014 Classroom Videos Kaplan 2018 Bio Book 1/2 of Zanki 4 blocks of Bio + 2 blocks of Genetics [80%] 1 month Micro + Antimicrobials Sketchy + B&B in general micro — Pepper 6 blocks of Micro + 1 block of anti-microbials (Pharma > Infectious Diseases) [94%] 1 month Pharma Sketchy + Kaplan in general pharma — Pepper 9 blocks of Pharma random systems [95%] 1 month Pathology 1st 8 chapters of Pathoma + About 1/2 of SketchyPath — Pepper or Duke for Pathoma chapters + SALT for Sketchy chapters 15 blocks of Pathology random systems [92%] 2 months Anatomy Kaplan 2014 Classroom Videos — Brosencephalon Total 7 blocks random systems (Anatomy + Histology + Embryology) [85%] 1 month Immunology B&B — USMLE-Rx Flash Facts 2016 + Lightyear 2 blocks [95%] 1.5 weeks Behavioural Both B&B & Kaplan only in ethics & physician-patient relationship BRS PDF: only in ethics & physicianpatient relationship Zanki 4 blocks 2 weeks Physiology 1st 2 lectures of Kaplan 2014 Classroom Videos + a few videos from B&B — USMLE-Rx Flash Facts 2016 4 blocks random systems [92%] 2 weeks *** I consider this to be extremely slow, so don’t take it as a standard but take it as an upper limit. I wrote down the rough duration because I don’t remember the exact time spent on each subject. In addition, there were some overlaps & time gaps between these subjects. For example; I started immunology after micro then I took a pause & finished it after anatomy.
(B) Final 1.5 months: I didn’t study much during the final weeks due to burnout & worrying about other matters (other than the step 1 exam). Mainly I did UWorld pathophysiology blocks (Retrospectively, I think these are best done with pathology), as well as the above self-assessments. I also stopped reviewing my daily Anki cards a few weeks before the exam out of boredom.
Exam Day Experience (including the days before & after): - As mentioned above, I didn’t study much during the last days before the exam. Relax; you have worked hard for months & any lastminute cramming is unlikely to benefit you. - The only significant change that I made during the last 2 weeks before the exam was adjusting my biological clock so I sleep only at night. In addition, I stopped using coffee or other caffeine-containing beverages so that I can use black coffee the day of the exam with its full effect. - At exam night, I took 3 tablets of diphenhydramine 0.25 to help me sleep but I only slept for 3-4 hours. - Left my home so that I can reach the Prometric center 1 hour early (Don’t take chances the morning of the exam). - Had my own earplugs; they were much more convenient than the ones given to you in the exam room (They allow you to have your own earplugs in the secure testing area).
Had a cup of double black coffee just before the exam (Preferably without sugar to prevent hypoglycemia 1-2 hours later) - Exam questions & interface were most similar to Free 120 Q’s. - Time management was not a problem as in step 2CK exam. I had at least a spare 5 minutes at the end of each block to review my marked questions. The only exception was the first block which I finished just as the time of ran out without a chance to review the marked questions (Probably because I was still warming up & adjusting to the questions.) - I marked about 8 questions in each block. These are the question I didn’t know their answer & wanted to go back to them to try to make the best educated guess. There were other questions I didn’t know but I didn’t mark them because the questions seemed impossible to guess. - I took 2 breaks; 1 after the first 3 blocks & the other before the last block. - My snacks during breaks were energy bars. This makes sure to eliminate hunger without making you full. - Honestly, after the exam, I didn’t remember any question except some marked questions in the last block. I had a long way home so I tried to remember some exam questions during the way back home. I recalled about 12 of my marked questions & when I checked them in the First Aid pdf, I had at least 6 wrong questions which were given directly in First Aid. - You may have dysphoria the days after exam due to the sudden relief of significant stress, try to relax these days. - Worrying about exam results will probably peak the days before the result comes out, so try to make yourself busy these days to avoid excess anxiety.
Remarks about different Step 1 Resources: 1) UWorld: A famous acronym for Step 1 Resources essential for achieving a high score is UFAP (UWorld, First Aid, Pathoma) with the recent addition of S for Sketchy Micro. Having said that, I believe that UWorld is the only resource that “must” be studied to achieve a high score. I know many examinees who got 260+ on step 1 without using FA or pathoma, but I’ve never seen anyone who achieved a high score without using UWorld. However, only one run is enough to reap its benefits & redoing your incorrect & marked questions or redoing all of the Qbank is completely optional. There are multiple approaches: a) Subjectwise/Systemwise vs Random: I did UWorld subjectwise after each subject. The pros of this approach are: To break the monotony of normal studying with questions To learn how to apply your freshly-learned concepts on clinical vignettes To better understand the concepts that you have just learned. UWorld explanations help you understand the concepts better than any other resource. Doing the whole Qbank random can be overwhelming - especially if you take notes - because the number of questions is now staggering (about 2800 questions, each one with about 1 page of explanation). If you do it by subjects, you break up this 3000-pages textbook into smaller chunks that are more manageable. The cons: Some people, including many who got 260+, argue that since UWorld questions are most similar to exam questions, you should do UWorld timed randomwise from the first time to best mimic exam questions. However, bear in mind that near your exam you will do a lot of self-assessments, which are all random. If you only did UWSA1, UWSA2 & Free 120Qs before your exam, these amount to 440 questions which are very similar to the exam, so I think these are enough to train you for the random nature of the exam questions. And, of course, there are the NBMEs which are also random & timed. UWorld is not perfectly organized, so expect to see some questions from other subjects incorrectly categorized under the subject you are doing. However, these questions are few in number. Many people argue that this approach can give you a false sense of security because you get many questions right just because you know the subject/system. However, I found this to be minimal in the subjectwise approach; this problem may be more significant in the systemwise approach. In addition, remember that the main reason is to apply & understand; your correct percentage is less important here. b) Tutor Untimed vs Timed: When you create a new test in UWorld, you can turn on Tutor Mode &/or Timed Mode. If you want to follow the subjectwise/systemwise approach, then turn on the Tutor Mode & turn off the Timed Mode. Tutor mode makes the answer & explanation appear immediately after you answer the question instead of showing the explanations of the whole test after you finish it. This goes well along with the subjectwise approach because the point here is to apply & integrate concepts, so seeing the answer immediately after doing the question achieves this purpose best. Timed Mode puts a time limit for the whole block. Again, turn it off if you follow the subjectwise approach because the very act of struggling to recall the facts solidify them in your brain. In addition, you want to take your time trying to make an educated guess to the questions you don’t know so that you slowly develop your test-taking skills. Obviously, if you want to follow the random approach, you should turn Tutor Mode off & Timed Mode on to best simulate the exam experience. Also, remember to make each exam 40 questions like the real exam. 2) First Aid: FA is known as the bible of step 1 because it supposedly contains a lot of high-yield facts that are frequently tested. I was planning to study it but didn’t have time. I tried to read some topics during my first run through subjects but found it to be very dull because it lists a dense amount of facts without putting them in a proper context. I know many people who got 260+ in step 1 without ever reading FA & also many others who got 260+ & FA was their main resource, so there’s no rule here. If I can give you advice, it’s best to read FA after doing UWorld in the same subject/system to give the facts some sort of context. In addition, focus on low-hanging fruits (ie, easily memorized facts or easily learned concepts) & concepts that are also mentioned in UWorld or other step 1 resources. From my select readings in FA, I found it has its share of lower-yield facts, too. So, don’t feel compelled to memorize every single fact in FA, as many people advise. 3) Pathoma: During my study for step 2CK, I struggled with anemias & coagulation disorders & a friend of mine advised me to watch Pathoma videos for these topics. I loved Dr. Sattar’s way of explaining the pathophysiology of disease manifestations (eg, why target cells have this appearance). I initially planned on watching all of Pathoma videos during my step 1 study, but after the 1st 5 chapters, it was downhill & I felt that the videos are only listing a bunch of facts without much conceptual explanation. I gave up on completing the
Pathoma after watching a while. However, I still think that the first 3-5 chapters are excellent & should be watched. His explanation of the morphological stages of MI in the cardiac chapter is also phenomenal & helped me greatly. 4) Sketchy: I fell in love with SketchyMicro from the first few videos because it made microbiology seem incredibly fun instead of being the dull, boring subject that I studied during medical school. In addition, I was surprised when doing UWorld questions by my ability to get many questions right due to my ability to recall completely random facts due to the sketches alone. SketchyPharm videos are longer than those of micro & the sketches are more complicated, necessitating revision of the sketches if you want to depend on them for recall. However, bear in mind that Pharma is a much higher-yield subject with lots of random facts, so longer videos are reasonable. Although I had a good basis of pharmacology from both medical school & step 2CK study, Sketchy Pharm helped me tremendously. SketchyPath is the most controversial because it is the longest (50 hours total) & because the sketches are complex & stuffed with useless items that are easier to be learned conceptually rather than by a sketch. In my opinion, you can use it for topics that need heavy memorization of random facts (facts that are not conceptually interconnected) e.g. all tumors in all systems, vasculitides, all of neurology, and all of renal. 5) Kaplan: Kaplan videos favor depth over comprehension, meaning they cover much fewer topics than most other step 1 resources but with slow, step-by-step teaching so that the concepts are drilled into your mind. Most IMGs use Kaplan for all subjects except pathology, which they do from Pathoma. However, I think that doing Kaplan in most other subjects is also unnecessary With Sketchy being more than enough in Micro & Pharma, you should also skip Kaplan in these two subjects (except maybe the general principles in each one). You can also skip Anatomy if you don’t have time; I honestly didn’t feel that Kaplan Anatomy helped at all, especially that it’s a memorization-heavy subject & Kaplan generally helps more with understanding rather than memorization. I didn’t do Behavioural Sciences because I had a good background from step 2CK study but if this is your first step, do only the videos on biostatistics/epidemiology & ethics/physician-patient relationship. Many people swear by Kaplan Physiology videos but I didn’t do them; decide according to your time. Kaplan Biochemistry videos (2014 version) are the most important since most IMGs have a very bad background on biochemistry. 6) Boards & Beyond: This resource is gaining immense popularity nowadays. I didn’t find it that good, but it covers much more topics than Kaplan with a much faster pace. Try it & try Kaplan & decide which style suits you better. However, bear in mind that Kaplan covers much fewer topics so you would need to supplement it with other resources. B&B cover most high-yield topics but the style of teaching isn’t that attractive. In addition, Kaplan uses the subjectwise approach while B&B uses the systemwise approach so B&B won’t be as convenient if you study subjectwise. If you use B&B, don’t use it for micro & pharma (because they are better covered by Sketchy) & general pathology (because this is covered better by Pathoma). Another advantage of B&B is that there’s a premade Anki deck based on all of B&B videos. This deck (called Lightyear) is divided into sections with each section covering a single B&B video. The workflow with this deck should be convenient, since you will do the video, transfer the cards related to this video to your deck, then do the cards. In contrast, there’s no Anki deck based on Kaplan videos. However, this deck is not perfect; it contains a huge number of repeat cards & sometimes skips some important concepts emphasized by Dr. Ryan in the videos. 7) Anki: If I wanted to write all my thoughts on Anki, including my opinion on the different premade Anki decks, this would take at least 20 pages. Instead, I will give you links to webpages explaining the process: The first article I read that made me consider Anki during step 2CK study: https://www.yousmle.com/usmle-world-step-1-note-taking/ MedSchool + Anki (a webpage explaining the concept to newcomers): https://www.medschoolanki.com/ Medical School Anki (a subreddit about using Anki for medical school, all the premade decks are available here on the right side): https://www.reddit.com/r/medicalschoolanki/ AnKing (a youtube channel teaching you the technical aspects of Anki in details): https://www.youtube.com/TheAnKing An article from a Harvard student with tips on how to create good Anki cards: https://www.usmlepro.com/upro-blog/the-secret-to-usmle-success-spaced-repetition Another good article on how to use Anki for medical school: https://medshamim.com/med/anki-step-one
Remarks about different Step 1 Subjects: 1) Pathology: About half the exam questions are supposedly questions about specific diseases, not drugs or basic principles. This is reflected in the major Step 1 resources; more than 1/3 of FA is pure pathology & more than 1/4 of UW questions are pathology questions (1/2 if you consider pathophysiology questions, which should be done with pathology). Pathology is partly comprehension & partly memorization, with most neoplasia-related topics & morphology-related facts being mostly memorization. The general pathology part is extremely high-yield & should be done from pathoma (1st 3 chapters). You can also use the general pathology part of FA but do it after you finish the systems to make it easier. For the pathology of organ systems, the classic approach is to use Pathoma then FA then UWorld. However, as I mentioned above, pathoma is much worse in the organ systems than in general pathology. If you feel that you are not getting any benefit from the videos, then use FA + SketchyPath in select topics (as above) + UWorld. These should be more than enough. I actually didn’t use FA & relied on UWorld & some videos of SketchyPath & this turned out very well.
2) Pharmacology: In my opinion, this is the 2nd most important subject & the lowest hanging fruit. Pharmacology questions are abundant & easy points on the exam because they are straightforward & are covered by most Step 1 resources. So, if you memorize your drugs well, you will get most questions right without needing good exam-taking skills. In my opinion, FA is an overkill in this subject because it contains lots of lower-yield facts which are much less likely to appear on the exam (eg, some low-yield uses of anti-neoplastic drugs, some non-specific side effects of some drugs). Use Sketchy Pharma + a Sketchy-based Anki Deck (Zanki or Pepper) for the specific drugs + Kaplan/B&B for general pharmacology, immunosuppressive agents, and reproductive drugs (These are not present in Sketchy). After that, do UWorld Pharma random systems & take notes (either on Anki, a word document or on paper). Alternatively, you can use UWorld only if you are short on time & had a good grasp on pharmacology in medical school. I believe UWorld alone is enough for pharmacology. If you have time, you can skim FA for new drugs you didn’t see in the above resources. Don’t get bogged down on the details of drugs in FA, just know the names of the new drugs & a hint about each one & move on. I didn’t have time to do that but I think this can be beneficial. 3) Physiology: Although this subject is considered one of the high-yield “3 P’s”, I felt that pure physiology is not as high-yield as it is supposed to be. Most physiology-related questions are about pathophysiology (eg, shock, EKGs, heart sounds, obstructive vs. restrictive PFTs, … etc), which I felt more covered by pathology &/or Internal Medicine rather than physiology. If you had a good grasp of Internal Medicine during your medical school, pathophysiology should be easy. Pure physiology questions are also important but are less frequent, FA should be enough for these. There are multiple equations that need heavy memorization; be sure to use Anki. There are multiple resources for physiology & the most popular 3 are Kaplan 2014, B&B, & BRS. I tried a bit of each one but didn’t have time to do any of these. The paradox of choice can leave you paralyzed so decide which resource you like the best, study it, and move on. As I said above, UWorld is the only essential source; I mainly studied UWorld & Rx Flash Facts deck & my performance in physiology was as good as other subjects. 4) Microbiology: Not much to say here; Sketchy micro will make this subject the easiest one. Add Kaplan or B&B for general bacteriology & general virology, there’s no point in watching Kaplan or B&B for specific microbes. Do UWorld to fill the gaps of Sketchy micro. If you mastered these; FA should be completely optional. The only important addition in FA is the algorithm of Gram +ve bacteria & the algorithm of Gm –ve bacteria because they are extremely high-yield & are not covered very well by Sketchy. These algorithms are the only thing I studied from FA. You can quickly skim FA to determine whether there are any specific topics you should read from it, but don’t be obsessive about little details. 5) Immunology: A small part that is heavy on memorization of volatile material. Don’t do it before doing pathology because many concepts are explained much better in general pathology. Also, do the immunodeficiency chapter in SketchyPath. Again, memorization is best achieved by Anki so I relied heavily on Anki for this subject. 6) Biochemistry, Molecular Biology & Genetics: Most people, including myself, struggle with this subject. I struggled mostly with the metabolic pathways in the metabolism section. Mastery of biochemistry needs both memorization of volatile information & excellent understanding of key concepts. For understanding, Dr. Turco does an excellent job of explaining key biochemical & genetic concepts in Kaplan 2014 videos. For memorization, I think the optimal way is to use spaced repetition via Anki; Zanki deck is based on both Kaplan Bio 2014 Videos & FA2018, so it is the best option. I used to watch a Kaplan video while opening Anki in the background. Every time Dr. Turco mentions an important keyword, I searched for this word in my collection of premade decks & transferred the cards testing this concept to my own deck. At the end of the day, I would do all the cards in my deck. This was time-consuming but I learned 1/2 of Zanki Bio deck this way. You can instead watch all of Kaplan videos then do all of Zanki deck, but try to delete any cards that test useless low-yield details as you go. Unfortunately, although Kaplan 2014 Bio videos are excellent to drill key concepts, they only cover a small proportion of the potential testable biochemistry material. When I skimmed FA after finishing Kaplan videos, I was shocked to find that more than half the material in FA Bio Section was not mentioned at all in Kaplan videos. In addition, many UWorld questions tested concepts that were neither in Kaplan nor FA. Therefore, Boards & Beyond can become helpful in this case because it covers most topics in Kaplan, FA & UW. I only watched a few B&B genetics videos at the end of my preparation but didn’t have time for other videos. 7) Gross Anatomy: I didn’t expect this subject to be a problem because I studied it well during medical school & Kaplan videos felt easy enough. However, when I did UWorld, I found that there were a lot of questions that was not covered by either Kaplan nor FA. Even in the selfassessments & in the real exam, anatomy questions were the most difficult. You can’t guess here, you either know the answer or you will get the question wrong. However, the feedback in both self-assessments and in the real exam showed that my performance in anatomy was as good as the other subjects, probably because it is clumped together with embryology & neuroscience. I’ve heard that anatomy shelf-notes is high-yield but I didn’t have time for it. 8) Psychology & Psychiatry: This subject has been easy for me because it is well-covered in step 2CK & I think it’s very easy even for newcomers. I used Zanki flashcards then used UWorld & this was more than enough. 9) Public Health, Epidemiology & Biostatistics: This subject has also been easy for me because it is well-covered in step 2CK. The only annoying part is memorizing the equations & this can be easily achieved by Anki. Try to memorize the equations like the back of your hand so you don’t spend much time during these questions in the exam because they can easily chew off your block time (happened to me in step 2CK & made me leave a question at the end of a block unanswered). Other than equations, it’s mostly comprehension of key concepts. Again, I only used Zanki flashcards then used UWorld. 10) Ethics: This has been a significant weakness for me in both step 2CK & step 1. I did Kaplan videos, UWorld & Conrad Fischer’s 100 cases during my step 2CK study & it wasn’t enough for the Step 2CK exam. In step 1, I rewatched Kaplan ethics videos & did B&B, FA &
Zanki but also got many ethics questions wrong in UWorld. I realized that the main type of questions I got wrong was the questions which test what you should say to the patient, not the ethical principle itself (ie, Physician-Patient Relationship questions). I watched this part from Kaplan & also did it from BRS. I also tried to infer general rules from my wrong UWorld questions to get these questions right (eg, if a choice includes further history taking, it is usually the right answer). Thankfully, ethics questions were not hard in the selfassessments nor the real exam after all that.
General Thoughts: The best advice I can give is to avoid long time gaps in the middle of your preparation as much as possible. You take a significant time to rebound after such breaks & you easily forget what you studied before. If personal circumstances arise, you can take 2-3 weeks as needed. If you have to take a longer break, try to study 1-2 hours daily so that you don’t take much time rebounding after a break. Your performance in the step 1 exam depends on your cumulative knowledge throughout your previous medical education & your total preparation period. In other words, if you couldn’t study well during the few weeks prior to the exam due to any cause, chances are this wouldn’t hurt you as much as you would think. As long as you mastered enough high-yield concepts throughout your preparation, you should be completely fine. The skill of making an educated guess is critical for a high score. A large proportion of the questions I got right in UWorld & selfassessments were about concepts I didn’t know while a large proportion of the questions I got wrong was actually about concepts I knew well. This demonstrates the value of the test-taking skill. This skill can be easily acquired when solving UWorld questions by selfreflection & analyzing your approach to difficult questions afterward. Don’t obsess over a specific topic you can’t understand or memorize. The range of testable topics is massive, and the probability of seeing this specific topic on the exam is slim. I’ve experienced this first hand in both USMLE steps: I frequently researched some difficult topics & struggled with them for a long time only to find later that they are not tested by either NBMEs nor in the real exam. Instead, try to cover a wide range of high-yield topics with moderate depth. This is better than covering a narrow range of topics with marked depth. Of course, this applies the most on medium-yield topics. Don’t spend too much time deciding which resource to use. There’s no magic resource for step 1, despite most people thinking otherwise. Try some of the most popular resources at first, then decide which resource to stick to & move on. Don’t second guess yourself in the middle of the journey. Hesitancy about which resource to use in each subject wastes significant time, contributes to feelings of being overwhelmed, and is a significant reason for low scores & long preparation periods.
Finally, know that no matter how much pain you experience in this journey, you WILL achieve. No matter how much frustration & disappointment you pass through, you WILL succeed, sooner or later. May you all achieve your magnificent dreams Insha’Allah.