Dr : Sebastian Gallo Bernal Hello everyone! Very long post ahead

Dr : Sebastian Gallo Bernal
Hello everyone! Very long post ahead.
As I promised in my last post, I’ll try to summarize my USMLE Step 1 experience. I know that many of you reading this post are struggling with the same problem I faced at the beginning of my journey: preparing for this exam while working or studying for med-school. I am writing this review to share my experience; I think it is time to give back to this community. I will try to be honest in everything and share my perspectives.
I took the first steps of this journey while working part-time in a research facility. I really wanted to take the exam before my internship year. However, due to a couple of serious personal problems, I decided to postpone it until my Social-work Year (which I did in the facility as mentioned above). At first, I thought I had taken the worst decision of my entire life… It was tough to manage times, and I was tired most of the time. However, thanks to this part-time job, I published an important number of abstracts and articles in peer-review journals. I also gained the experience that helped me find a postdoctoral research fellow in a top university-hospital in the United States. I’ll try to make a particular post on getting into a research position or postdoctoral research fellow in the United States.
Don’t get me wrong. I’m not going to lie; it was hard, and there is no magic recipe or fast track for doing this in an “easy way”. A substantial amount of effort and dedication is needed. However, keep in mind your final goal and lead your dreams to be your motor. Set your goals, determine yourself, and never look back. Persistence in every aspect of life should be your everyday resolution.
This post will be divided into a couple of brief sections to make it easier to read. I will talk about the beginning of everything, the resources I used, my timeline, the problems I faced, assessments, and the strategies I found to be more efficient. Feel free to jump to the section you prefer.
As a summary of everything I will talk about, I genuinely believe that the most efficient way of obtaining a terrific score is to solve as many questions as you can. I am sure this is not the only approach for getting a good score… however, I think it is solid and cost-effective way of doing it.
There are dozens of q-banks, and I will briefly write about which ones I found to be more useful.
When I started step 1 preparation, I read many high scorers’ experiences and many posts on Reddit. I wanted to have the best evidence before making a plan. However, after reading many posts, I still had many questions to which I really found no answer. Things like how much time it takes to study each resource, where to start First Aid, or How to study UWorld effectively were still bothering me. Besides, I was worried about the overwhelming amount of resources and the relative lack of consensus between high scorers on which ones were better. However, I understood that to succeed, the following was needed:
• Found the bases and understand the concepts (a.k.a reading/watching videos): you need to understand before applying. However, if you rely solely on reading/watching videos for your preparation, you’ll hardly get a good score. Suppose you are continually getting very low grades on your assessments. You notice most of your mistakes are “silly” mistakes. In that case, this will not change by using additional or more complicated resources. Don’t waste a lot of time on this item, especially if you don’t have a lot of time to waste :wink:.
• Memorize (a.k.a space repetition)
• Learn how to apply (a.k.a q-banks and learn how to answer a freaking 8-hours exam): this is crucial. As a matter of fact, this may be the most crucial step for crushing this exam.
Importantly, I understood that these 3 things didn’t have a chronological hierarchy; all should be done together as a whole. However, as you will see later, I eventually decided to stop "gaining: knowledge and start applying it.
My first advice is, don’t accumulate a lot of resources. I made the mistake of thinking that more and more vast resources (more reading or more video watching) were equal to more knowledge. I thought I needed to read every single book and watch every single video in order to understand a topic, but that, my friends, is a lie.
If you want to learn how to drive, you have to sit in front of a car. If you want to learn how to effectively solve an exam, you must practice by solving questions. It is natural to feel you are forgetting everything you just read. Our brains evolved to retain “useful” information (for survival) and not a bunch of ““fun medical facts””. IF YOU WANT TO RETAIN INFORMATION, YOU HAVE TO LEARN IT USING A PRACTICAL AND ACTIVE APPROACH! Passive learning is useless.
For understanding the concepts
• BIOCHEMISTRY and GENETICS: Kaplan lecture notes (GOLD). I also read a couple of chapters of Lippincot’s biochemistry; however, on retrospective, it was a waste of time. In the last months, I saw some BNB videos, which helped me a lot. I wished I had found BNB before; it is terrific for Biochemistry.
• PHYSIOLOGY: BRS physiology by Constanzo (GOLD). I think this was one of the books I enjoyed the most. It is very straightforward but has everything you need for the USMLE step-1. For respiratory, I also watched BNB videos (GOLD).
• IMMUNOLOGY: Kaplan lecture notes and on-demand videos (GOLD). A lot of people hate Kaplan… yes, it is time-consuming, and it is not bullshit-free. However, for some topics (such as immuno), it is excellent.
• MICROBIOLOGY: Kaplan lecture notes. It is too long and has some very low-yield things; however, it may help you have knowledge-gaps. I also used Sketchy (GOLD). I was able to answer everything on the exam with the knowledge I got from sketchy.
• ANATOMY and EMBRYOLOGY: Kaplan lectures for neuroanatomy (GOLD). BNB also has fantastic videos on the neurology section. For general anatomy, I read Kaplan and used Dorian’s Anki deck.
• PATHOLOGY: more than 65% of the exam is pathology-related. I used Goljan during med-school, and I was familiarized with the book. I love it, even though it is incredibly long and has some mistakes. If you decide to read it, be prepared to spend at least 1.5 months. I know many people love Pathoma; however, I did not use it as I was used to reading Goljan.
• PHARMACOLOGY: Kaplan lecture notes and on-demand videos. I regret doing Kaplan for this topic; time-consuming and very low-yield. Use BNB instead (GOLD). With the exam changes, focus solely on basic pharma. Try not to memorize names or specific treatments; they are not asked anymore. Focus on mechanisms of actions, pharmacokinetics (a lot of questions), and basic concepts of interactions.
• BIOSTATISTICS: UWorld biostatistics is beautiful. You can use it as a learning tool. It is cheap and high-yield. On the exam, I was asked to make 6 or 7 calculations (mostly OR or sensitivities/specificities). If you think you need a little boost, go for BNB.
• BEHAVIORAL SCIENCES AND ETHICS: my intention was to take the exam before the “October” changes. However, my exam was canceled on two opportunities due to corona, and October 27th was the only available day. Again, I am not going to lie to you… I am terrible at solving these kinds of questions. As a matter of fact, this was my worst subject in all the assessments I took. Many IMGs struggle with this area, as our health systems are so different from the American. I did Kaplan lecture-notes and 100-cases in ethics. Do 100 cases with caution: it gives you the basis for many questions but also talks about many WTF topics that are not evenly remotely asked on the exam. The new questions are more related to communication and not to ethics. I mean, they were not the classic legal or ethical dilemmas, but more the kind of how to give bad news, how to encourage change or how to promote treatment adherence. The best way of preparing for this area is by doing a lot of questions (UW and Amboss are similar to what is asked in the exam).
For memorizing:
• Anki is a powerful tool for spaced repetition. However, as I will explain in a bit, maybe you can skip it if you don’t feel comfortable with it. Initially, I used the Anking deck; however, I quickly realized that I wasn’t learning anything. I was memorizing what someone else thought was important. Don’t get me wrong… many of these premade decks are magnificent. However, if you don’t understand what you are memorizing, you are just literally wasting time. My advice is, try to make your own cards, with your own knowledge and words. This way, you will memorize the details you need for recalling what you just learned.
• QUESTIONS, QUESTIONS, and MORE QUESTIONS: this is the ultimate way of doing active spaced repetition. THE EXAM IS ABOUT SOLVING 280 QUESTIONS AND NOT ABOUT WATCHING VIDEOS OR READING BOOKS LIKE A PRO. I understand this a little late, and I am sure my prep would have been shorter if I had noticed it before.
• FA: This was the first crash on my journey; the most known and famous resource for USMLE step1 preparation, AND I REALLY COULDN’T HANDLE IT. I tried to read it in a million opportunities, and I just couldn’t… I heard about people reading this freaking book 5 or 6 times, and I really thought it was necessary for doing the exam. Besides, I was hoping to rely on this resource for remembering what I was constantly forgetting since the beginning. I felt frustrated and anxious; for ME (and only me), FA was just a bunch of ““fun-facts”” without a background. My brain really does not work in that way.
• AMBOSS (gold, gold, pure gold): The most unfairly underrated and underestimated resource. By the end of my preparation, I used Amboss as I think most people use FA. Whenever I wanted to review something, I just looked in the library. Apply for a scholarship… in the worst-case scenario, you will get a discount coupon.
Qbanks: as I already stated, do as many questions as you can. I used the following q-banks in the following order. In parenthesis, my final percentage of correct answers.
• Kaplan (79%): it was a gift from my university. I started doing it from day 0. As I wasn’t used to answering questions, I began with 10 questions and gradually increased it until I reached 40 qs a day. It is an excellent bank to begin your preparation. However, the style of questions is different from the real exam. I used it for the first 3 months.
• Rx (85%): I liked it. They also extended my subscription due to covid, which was really helpful. I also enjoyed the explanations of this q-bank, and some of the questions were similar to the exam. If you are doing FA, you will love this bank. I skipped the ““easy”” questions. I did 20 to 40 questions a day and finished it in 3 months.
• UWorld (92%): the king. Good explanations and the questions are incredibly similar to my exam. I actually felt I was solving UW blocks. I know many people do UW a zillion times, but I just did 1 round, plus a marked and incorrect round (I marked around 700 questions). I think doing UW more than 2 times is just a waste of time (you memorize the correct answer and not the explanation). Like true-love, UW should arrive to your life at the correct time. I will strongly advise against doing it from the beginning; try to “warm-up” a little with other resources so that you can really take advantage of its infinite knowledge.
• Amboss (92%): it is extremely useful for the last stages of your preparation. Even the WTF-5-hammers questions are useful. Reviewing Amboss’s questions is very easy; most explanations are short, with a low amount of bullshit. I especially used Amboss in the last weeks to get stamina and endurance. I gradually increased the number of questions until I was doing 200-280 questions per session.
• Total time: about 13 months.
• Watching videos/reading books: 7 months
• Dedicated period to only solving questions: 6 months
I finished med school in August 2019 and started my preparation in September. I used 1 week to make my plan and collect all the resources. For the first 7 months (until April 2020), I used to work in the morning. I took advantage of my free time while working to do as many Anki cards as I could. Once I was free (about 1 PM), I used to take lunch and then started my routine. I studied for 7 hours daily (until 9 or 10 PM). My routine always began with questions. On a regular work-day, I used to do 20 or 25 questions. I always did them on time-mode and random (as the real exam!). I spent about 3 hours solving and reviewing them, and the rest of my time, I read or watched videos. I used the Pomodoro technique to optimize time. I know this sounds like crap, but there is evidence supporting pomodoros of 35 minutes. On weekends, I used to solve 40-60 questions. I did not revise the first q-banks in great detail (sometimes I only read the explanation for the correct answer).
For the first 2 months, I studied every day, even Saturdays and Sundays (HUGE MISTAKE). I was burnout in a couple of weeks. I took a short break in December and decided to stop studying on Sundays. This journey is long and exhausting; give yourself at least 1 day to do NOTHING.
I was committed to spending no more than 4 weeks per subject. I studied biochemistry, microbiology, and immunology from Kaplan’s and physiology from BRS. I also started Sketchy micro. I printed all sketchy pictures and annotated each story’s critical points on the reverse so that I would remember all the characteristics of bugs while imagining those sketchy pictures. Watch it just like a TV show, and you will memorize the whole micro at the end. By the end of December, I finished Kaplan’s q-bank.
Ironically, thanks to the COVID pandemic, I had more time to study. I finished Sketchy by mid-January. I then started pharmacology from Kaplan’s and gave a quick review of some chapters of Goljan’s.
As I was doing research, I was good with biostatistics and epidemiology. As a result, I decided to stick with the UW-biostatistics review. By mid-February, I started doing anatomy and embryology from Kaplan’s. I discovered the magic of BNB a little bit late. Still, I decided to watch all the anatomy and embryology videos. At the end of this period, I studied behavioral sciences by reading 100-cases of ethics and reading Kaplan’s lecture notes. I finished Rx Q-bank by April.
By the end of April, two things happened in my life: I quit my job, and I realized I had forgotten a lot of what I read. I thought FA was going to be my salvation, but I eventually realized I hated that book. As a result, I took the best decision of my life: to solve and review many questions per day. I decided to use this method as a form of spaced repetition. I stopped reading and watching videos by this time.
In the first couple of months, I solved 1.5 UW blocks per day. Eventually, I increased this number to 2 blocks daily. By August, I decided to do 1 block of UW and 1.5 blocks of Amboss per day. I progressively increased the number of questions until I was doing 200 questions per day by October. In this final stage, I decided to take a break every 2 days to avoid burnout.
The day before my exam, I reviewed and memorized the formulas in the last pages of FA. I stopped working by 3 PM.
I started with one of the oldest NBMEs (I really don’t remember which one). However, all NBMEs older than form 13 are too different from the real exam and ask many WTF questions. If you decide to solve them, only use them as a learning tool. I did all NBMEs online.
• NBME 13: 238 (before UW)
• NMBE 15: 235 (While doing UW)
• NMBE 16: 245 (While doing UW)–>I SCHEDULED THE EXAM AFTER NBME 16; however, they canceled my exam on 2 different occasions.
• NBME 17: 252 (While doing UW)
• NBME 19: 241(While doing UW)
• NBME 20: 255 (While doing UW) 2 months before the exam
• NBME 21: 255; 7 weeks before the exam
• NBME 22: 257; 5 weeks before the exam
• NBME 23: 263; 4 weeks before the exam
• NBME 24: 252; 6 weeks before the exam
• NBME 18: 263; 1 week before the exam.
• UWSA 1: 273; 3 weeks before the exam
• UWSA 2: 265; 2 weeks before the exam
• FREE 120 (in Prometric): 92%; 2 weeks before the exam (DO IT IN PROMETRIC AND TO IT A COUPLE OF WEEKS BEFORE THE EXAM; I GOT 5 QUESTIONS FROM IT).
• While reading, watching videos, or reviewing questions, TRY TO USE THE POMODORO TECHNIQUE. Use pomodoros of 35 minutes (I know this will sound like bullshit, but scientific evidence supports this exact time).
• Do as many questions as you can and begin doing them early in your preparation. This will boost your knowledge, confidence, stamina, and endurance. Solving questions is the ultimate form of spaced repetition.
• In the exam, you need to solve questions like a pro. Reading or watching videos will not train you for this. Don’t accumulate a lot of resources thinking that you will eventually memorize or understand something.
• An essential component of the exam is endurance; solving 280 questions is a superhuman task. Try to simulate the real exam a couple of times: wake-up at the same hour and do 7 blocks of questions. USE A FACEMASK FOR YOUR SIMULATIONS! If it is possible, eat the same thing you plan to eat the day of your exam. Do not improvise on these little things the day of your exam.
• Try to do the practice exam at Prometric; in this way, you will get to know the site and avoid uncomfortable surprises the day of your exam. Besides, if you do this practice test, you can skip the tutorial and win some extra break-time.
• On the day of your exam, don’t pack a huge lunch. As a matter of fact, I did not eat lunch that day; I ate small things every break (nuts, a small sandwich, cheese, olives).
• Try to take a break after every block. Wash your face, eat something, and drink water/coffee.
• Anticipate everything: bring some aspirin, an antidiarrheic, and something for gastroesophageal reflux.