Almighty has blessed with much more than I deserve and could ever imagine of (Alhamdulilah).
I’m from Lahore, Pakistan and took my Step 1 exam on 24th April, 2019. Was battling with thoughts of writing this up or not, however, in the end I thought I owe my share to the beautiful people like you who are reading this & are probably going through toughest phase of their life.
Important message:
I once saw a post on a page asking a question along with mentioning that only 250+ should respond. This broke my heart. It’s not in ones hands to go beyond doing hard work for months and then choosing a step 1 score of 250+. For me, it’s the worse form of mentality with which one can go into prep or exam. Yes you can plan, aim and then work on it. But, what if you make a goal of seeking perfection instead? In every aspect, from Physio to path and biochem to biostats and so on, trying to master everything you could & set a target not to lose a single MCQ? I think you will probably fight to the core and will surely land pretty above your aim & target. In my case, I can recall at least 3 MCQs which I changed from correct to incorrect due to over thinking at the last minute. Please do not judge people on scores. One can just have a bad luck that day or a poor sleep last night or simply could panic in the exam. (My day to day guide was the person sitting next to me in the library, he was not a 250+ yet I learned a lot from his mistakes and experience)
My timeline:
Total time = 3yrs (wasted time doing Kaplans twice, a Biggg blunder!!)
Dedicated = 1.5yrs (that too with a lot of breaks and Sundays off)
Study hours = 8-10hrs (that too with many breaks)
Uworld 1st pass = 75% correct
Then did marked/wrong Qs which were around 1000
Uworld 2nd pass = 94% correct
Then again did wrong Qs and some marked~600
Then did newly added Qs~150 (a week before exam)
Also did some ~400 Very Difficult level AMBOSS Qs
NBME 13 = 257 (11 mistakes)- 5 months out
NBME 15 = 14 mistakes (offline)
NBME 16 = 255 (15 mistakes)
NBME 17 = 13 mistakes (offline)
Practice 120 = 13 mistakes 1.5 month out
NBME 18 = 261 (13 mistakes)- 1 month out
AMBOSS = 267
UWSA-2 = 260 (21 mistakes)- 3 weeks out
UWSA-1 = 269 (20 mistakes)- 3 days out
Real deal = 259 (Alhamdulilah)
Resources used:
Kaplan (all except Patho)-Twice (1st read with 2014 videos, Dr. Harris, Sam Turco all of them were great I owe them a lot :’))
Goljan-Twice (1st read with audio lectures-Yes I’m old school & this one was personal 
)
FA’17-x4 times (Annotated additional stuff from FA’18 & ’19)
Additional resources: These were the resources I used after going through FA & Uworld first time, now that I knew my weaknesses very well and areas where I lagged.
- Uworld Biostats Notes
- Anatomy shelf notes
- High-Yield Biostats
- 100 cases by Khan & 100 cases by Conrad Fischer
- Some topics from High-Yield for Pelvic anatomy
- Google searches esp. for anatomy images
- A must study file (I got this from Usmle forums on FB and would like to thank this person who uploaded it, it had some really high yield points that were on my exam but never seen them on Uworld or FA)
Things I did differently:
- I never did Pathoma or watched any of its videos, if I had, it would have saved me a lot of time. I heard Dr. Sattar is brilliant but I was obsessed with Dr. Goljan and he’s GREAT!
- I annotated videos onto my kaplans that was a blunder. Then I wasted a whole year giving Kaplans a second read, my second blunder!! (I thought after memorizing kaplans I would be able to take exam in a month or two. I was wrong and heading without any plan. I didn’t seek anyone’s guidance and had no idea about FB pages too-till I met my Mentor a year back; Dr.HA, the Legend himself)
- I never knew anything about BnB or Anki and did not do any of these. It took an extra effort to understand every single line of FA but it was fun too, doing it yourself sorting things out.
- I had a total commute time of 1 hour from my workplace so I started watching DirtyUsmle videos on youtube. It was an awesome experience. The guy tells cra* mnemonics but he does cover the most high yield topics and I had many questions in exam which were reinforced through his videos.
- Biostats-the subject I dreaded the most, hence I wrote up all the formulas in my own simplified way and did some extra hard work to kill it in exam (Alhamdulilah)
- Ethics- every IMG should be afraid of it. My Uworld 1st pass was skewed by ethics and biostats. I even marked wrong options where the correct % was 97. Till the end I was unable to tackle it but Alhamdulilah, it was not a big deal in the real exam (Thanks to 100 case by Khan & Conrad).
- AMBOSS: My exam was due on 11th April but a day before I got an email that my exam was cancelled due to some technical issues at the Prometric. I had almost 15 extra days so I decided to solve AMBOSS Qs with a filter of only Very Difficult Qs. These were around 400 Qs. I was devastated. My correct % was barely around 50. But then I reassured myself that these were the only very difficult Qs out of an entire pool. Advantage- These Qs really got to my nerves, I could not get those scenarios or make any diagnosis at all. I tried to focus more on the key words and thereafter it helped me a lot to crack difficult & extensive Qs on the exam. They felt easier to me. Disadvantage- I lost a few Qs due to over thinking in the exam, as the concepts asked were simple but I thought there must be some trick in them
- I always had issues with the concepts of Respiratory physiology. I found it later on in my prep but found it extremely helpful even though I watched only half of them due to time constraints. I started watching Dr. John West’s videos on youtube. He’s an old school but definitely a Legend!
- I took time to complete every single read of FA (probably bcz I’m a slow learner). I took almost 30 days for my last read.
- I took a lot of time to complete Uworld 1st pass. Many a times it was just 5-10 Qs per day with annotations. I was really worried, max effort from morning to night would take me to just 20-25 Qs per day. But in the end, you start to memorize tables and concepts which are frequently repeated in other Qs too. So towards the end I was able to do a block a day. During the 2nd pass I started doing blocks in the morning and then reading the explanations on mobile where ever I found time to do so. Even while taking a walk at night I would read 10-15 Qs. That helped a lot! (I did Uworld on random/untutored mode). Please do differentiate it from exhaustion. Many times when one is over burdened with work in a monotonous routine, the productivity goes down. Try to take a day or two off, break your routine, watch a movie or hang out with friends. Its very important to refresh yourself otherwise keep on dragging yourself will bring your motivation level drastically down!
Exam delay:
At the end of February, I scheduled my exam to be on 11th of April. Those last 2 weeks were the most hectic and toughest in life. I overwhelmed myself with FA, uworld flash cards and my notes. Couldn’t get enough sleep (only~ 6 hours) due to exam stress. My brain was just not working with me anymore. I was completely exhausted but was ready to be done with this exam once and for all. Then all of a sudden I got this email of my exam being cancelled due to some technical issues at the Prometric. I was devastated as I already had a lot of domestic chores piled up and things due after my exam. The people around me told not to worry and relax, take it an opportunity to calm your nerves down. THIS WAS A DIVINE INTERVENTION! Had I taken my exam that day, I would have definitely panicked and messed up exam. Sleep deprived for the last 2 weeks, I took a break for 2 days and then resumed with prep. This time I was feeling relax. My sleep came back and all the pressure was gone. I later took my exam on 24th of April, but this time I was cool and calm, letting everything in the hands of Almighty. I would suggest, if any of you experience the same, there is no harm in delaying your exam for 1 or 2 week. A fresh mind within a cool and calm person can achieve much more than a sleep deprived.
Newer NBMEs:
Ever since I got the news of newer NBMEs coming out before my exam, I was confused whether to take any of these or not. At that time NBME 18 was thought to be the most predictive. And I had already spent a lot of money on Uworld. Here comes the role of my inspiration, Dr. A-U-R. He built up my hope that given my previous NBMEs I would definitely (insha’Allah) score 250 and asked what’s the point of taking the newer ones? Do I want to further predict my score or build up my knowledge/question pool? He told me not to waste a single penny as these are the tactics of NBME to earn dollars 
I got my answer and didn’t buy any of these. TECHNICAL PART: Here comes the role of this beautiful and an essential part of my prep-The USMLE Step 1 Forum . I came to know about this group through my mentor Dr. HA and joined it in 2019. I started following the newer NBMEs Qs posted on groups to improve my knowledge, have an idea about the concept and the difficulty level of Q asked. This compensated a lot. I did same with those old NBMEs that I skipped e.g 19,11,7
Exam day:
A day before exam, I overwhelmed myself with biostats, ecgs and murmurs. However most of the stuff other than ECGs/murmurs was of NO use. Went to bed at 10pm, tried to sleep, at 11 our electricity went out due to windstorm. At 12am I was still struggling to sleep without an AirConditioner. Finally, I never went to deep sleep that night. (I would like to mention the role of Sleeping Pills here. I tried a lot of them, during NBMEs. All of them had some sort of hang over, please do not take any pill a night before exam. You never know how your body is going to react to it. I took Melatonin 3mg before UWSA-2 and experienced the most severe hangover ever! Just make it a natural one and you will be fine iA) Got up at 5.30am, offered prayer. Took shower, had a cup of tea with omelet and toasts in breakfast. Took a cup of Black Coffee with me and left home around 7.15am. The prometric is 30minutes drive from my home. It was a pleasant sunny day. I felt so proud :’) I never thought that I would be able to take this exam in life and now I was on my way. I was very happy that finally it’s all going to end today, three years of ups and downs and uncertainty and now I was here standing in the parking lot of Prometric. I finished my coffee there, had a few bites of dark chocolate. Suddenly I realized that they had mentioned in their call that I had to be there at Prometric before 8.15am. So I started running up, the centre was a kilometer away from parking lot. This took away my sleep
The Exam:
My exam started around 8.50am. They asked me to check my headsets before starting exam, so I did that and skipped the tutorial entirely. Now I had a whole 1 hour of break time. I took my own Flents soft foam ear plugs with me and they did a wonderful job. All I could hear was my own breath sound :P. I was able to concentrate without wearing their big earphones or headsets. I took a lot of food with me like I was on some picnic. And that was awesome because if you make yourself at home, the anxiety and exhaustion goes away. I took 10 min break after every block, went to pee, washed my face, drank some tea with a mini sandwich, took a date or dark chocolate as dessert and rushed back to the exam. Protein bars were a flop, tasteless and difficult to chew, I took them back home as it is. Don’t push yourself towards 2+2+1+1 blah blah stereotype. Do whatever suits you best. During my NBMEs and UWSA, I realized that I tend to get tired & exhausted while doing 2 blocks back to back. So the strategy worked really well in the actual exam. Even so, I had enough time during my second last break that I offered my prayer too. The exam was very conceptual and I found it more like a UWSA 2. There were a lot of images esp. the skin lesions, they were all over my exam. Had 3-4 ECGs, 3-4 murmurs all pretty much doable if your concepts are good. I found biostats Qs a bit demanding, so I skipped all of these along with murmurs to do at the end to each block. I marked 15-20 Qs per block (bad old habits die hard 
:D). I had 10-15 mins left after each block to solve left over Qs and review. Microbiology Qs were all integrated with images or some sort of experiments. In my opinion, 80% of the Qs were concepts asked from Uworld and easily doable, some 10% required extra resources and time investment, another 5% tested distant memory and high IQ and the rest of 5% were from NOWHERE! Nonetheless I was reading an article from a test writer that many of the difficult Qs are experimental (means they are just added to check people response, they won’t be included in your score) so don’t worry much about them, try to give a logical answer. As I started my last block I had only 1 min of my break time left. I was tired but was excited to go home free :P. Finally, the 3 weeks period before result was full of self loathing & disgust. I realized how many blunders I had made. Saw a derma picture from my exam on an ad on FB and realized that I got another question wrong. My suggestion to all is to take it easy during exam, try to justify every rare option you mark because after all these are the simpler ones that we take seriously and kill ourselves with over thinking.
Things I should have done:
- Read Kaplan just once (with videos) and done it along with FA subject wise, so the annotations would go directly to the relevant pg of FA
- Done Uworld 1st pass subject wise along with FA, so again the annotations would go to the relevant topic on FA
- At least watched the Pathoma videos
- Joined USMLE Step 1 forums earlier in my prep
- Planned my prep well before time
- Maintained a healthy lifestyle (without any walk or exercise I started having severe backaches on multiple occasions, I even had to take few days off)
- Took a day or two off rather than just dragging myself in monotonous routine in times when I was exhausted/overworked
P.S: I know people have already posted the best experiences ever on this page. I never wanted to write it because my journey is definitely not the ideal one. But this one is only to give back something to the group that has given me so much. In the end, everyone is different, and have their own way of doing things. I just wanted to share mine so that if anyone can relate to it, may take some benefit. Almighty be with us all. Best of luck to all of those who are going to take exam sooner or later, you will be the winner i.A