My USMLE step 1 experience as IMG - Saad Javeed - Medium


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My name is Saad Javeed. I graduated MBBS from Sharif Medical and Dental College, Lahore, Pakistan in 2017. After graduation I moved to U.S. I received my USMLE Step 1 score a while ago, I scored 266 Alhumdulillah!
I was an average student during medical school. Never thought that I would be taking USMLEs. When I started my preparation, I didn’t even know that someone can cross 270’s in step 1. After finding out the experience of a guy who scored 276, I went into curiosity. How someone can get such a high score? Are they genius? Are they hard workers? That time I set my target and I wrote a note on my journal stated, “You, are getting 270s that’s it” Although I slacked a bit in my target score.

Friends! honestly, everything is doable. No one is born genius, genius is 1% talent and 99% hard work. Hard work works in real life. Set your goals, determine yourself and never look back. Persistence and perfection in every aspect of life should be your new year’s resolution.

I am writing this review to share my experience, I figured it is the time to give back to the community. There are some awesome people on USMLE forums who not only did hard work but also supported others in the form of reviews and experiences. Honestly, these people are my heroes.

When I started step 1 preparation, I read many high scorers’ experiences and had many questions and confusions to that I never found an answer. Like how much time does it take to study each resource? Where to start First Aid? How to study UWORLD effectively? I will try to cover each of these questions and all those things that concerned me during my preparation. I will try to be honest in everything, a lot of people does not like to share their weaknesses and timeline with people but I don’t mind sharing it. Below is my whole timeline in sequence. I hope you find it helpful.

Assessments
UWORLD 1st round- 82%
NBME 7 offline-18 mistakes
NBME 13 online-17 mistakes -248 (2.5 months left)
NBME 15 online- 16 mistakes- 250 (1.5 months left)
UWORLD 2nd round- 96%
NBME 11 offline-11 mistakes
NBME 16 online-17 mistakes- 252 (1 month left)
NBME 17 online-9 mistakes- 261 (2 weeks left)
NBME 19 online-10 mistakes- 259 (1.5 weeks left)
NBME 18 online-15 mistakes- 257 (4 days left)
UWSA 2 online-13 mistakes- 269 (2 days left)

Real Deal- 266 (November 19, 2018)

Resources
UFAP, UFAP, and UFAP are the most important resources (UFAP; UWORLD, First Aid & Pathoma)

Anatomy
Kaplan with lectures 2014 (lectures not recommended) in the start, then HY Anatomy + FA + UW + Shelf notes in the end.
Neuroanatomy
Kaplan with lectures 2014 + HY Neuroanatomy + FA + UW
Embryology
HY Embryo + FA + UW
Physiology
Kaplan with Lectures 2014 + FA + UW
Pathology
Pathoma with videos (GOLD) + FA + UW
Pharmacology
FA + UW + Sketchy for Antifungals, Antivirals
Biochemistry + Genetics
Kaplan with Sam Turco lectures 2014 (GOLD) + FA + UW
Immunology
Kaplan with lectures 2014 + FA + UW
Microbiology
Sketchy micro (GOLD) + FA + UW
Psychiatry
FA + UW
Biostats
Kaplan with lectures 2010 (I highly recommend 2010 lectures) + FA + UW
Ethics
FA + 100 cases of ethics + Khans 100 cases + UW

Timeline
Well, after graduation I moved to US. I started my preparation around August 2017. My plan was to take the exam during June-August triad 2018 but God had other plans for me. My uncle got sick, he went through a major complicated surgery that led him to ICU for 2 months. I couldn’t study efficiently during that time. But I never stopped, I was spending most of the time in ICU with him and I used to do a UWOLRD block in a day sitting next to him in an ICU cubicle. That maintained my pace even though my family was going through a hard time. I would suggest the same to you. Guys! never stop, do not let yourself go without working for a long time to avoid guilt at the end of the day. Even if you are doing one page, do it properly it will give you a sense of achievement before going to bed.

August-December 2017
• I did Kaplan anatomy, physiology, biochemistry, and immunology.
• Then I did Sketchy micro I would annotate everything on a separate file while watching videos and add any extra info I found in Kaplan micro (Kaplan is not important- I was overdoing it). Integrate all the bugs with pictures, I always reviewed micro with sketchy pictures so that I would remember all the characteristics of bugs while imagining those sketchy pictures. Honestly, I always hated micro during med school but sketchy made it really fun. Watch it just like a TV show and you will memorize the whole micro at the end.
• Towards the end of December, I realized that I have dumped a lot of time on Kaplan and not started FA that is really important. So, my advice is to start FA early enough during your preparation so that you can integrate Kaplan or any other resource with it.

January-April 2018 (First Aid- 1st read)
• In my opinion, FA is an excellent concise book. But you cannot understand it while reading for the first time unless you have a good grasp of background knowledge.
• I decided to do everything system wise from FA along with other resources, that was the turning point in my preparation. So, instead of doing Anatomy, embryology, physiology, pathology, and pharmacology separately that would take more than 6 months, in my opinion, I did everything in parallel. For example; if I started FA Cardiology
➢ I would do only cardio unit in HY anatomy then read corresponding FA section.
➢ Then read cardio in HY embryology plus corresponding FA section.
➢ Then review cardio physiology Kaplan plus FA section.
➢ Then cardio pathology from Pathoma plus FA section.
➢ Then cardio pharmacology FA.
➢ Ending whole cardio with a quick review
I did every system from FA using this method. It took almost 3–5 days on average to understand and master the system. I regret not starting this method at the start of my preparation. In this approach, you can integrate FA along with multiple resources without being lost in a single subject.
• After completing all the systems, I spent the whole week on Biostats and epidemiology that was a tough subject for me because I am not that good at math. But a small effort in this subject can make a real difference in your score. I took Khan academy lectures on statistics that were really good. I watched Kaplan 2010 Dr. Stephen Daugherty’s lectures that are the gold standard.

May-July 2018 (First Aid 2nd review + UWORLD)
• I bought 6 months UWORLD subscription. I decided to do it system wise in Timed mode. This is really important, first-Why system wise ? Because UW is a learning tool with immense information. If you are doing random mode you cannot efficiently integrate it with corresponding units on FA. You don’t want to ignore all the details and you have to annotate that info on your FA or computer whatever is easy for you. I used both methods. I used to save all the histology pictures and tables in flashcards online, and annotate text information on sticky notes. My FA book was full of UW sticky notes towards the end. So, all the new information from UW done with corresponding FA, integrated together to make a whole new picture in my mind. Doing UW changed my perspective of looking into the clinical vignette. Second-Why timed mode? Timing yourself while doing questions is really important and
goes a long way. Its all about practice to get yourself prepared for the real exam, right? I never did a question without timed mode. Even if I had 5 questions left I would do it in timed mode. Even if you are doing offline question do it in timed mode and don’t cheat on yourself.
• It took me almost 90 days to complete UW along with FA 2nd review. I had placed 60 days in my schedule but I lost my pace due to family issues as I already mentioned. You can easily do it in 60 days at one block per day pace.

August-September 2018 (First Aid 3rd review + Annotated UWORLD)
• I started reviewing FA with annotated UW. This is really a crucial time during your prep. You have all the knowledge but maintaining that knowledge is the hardest part. And rushing your review for the sake of completeness is not a good approach. Understand it properly, don’t worry about the time, doing it once but properly is better than reading over and over again.
• I didn’t take NBME until I was sure that I have a good grasp of knowledge, I don’t regret this decision because low score in NBME can hurt your self-confidence but you should not delay NBME towards the end because if you get a low score you don’t have time to improve your weak subjects. So, you have to balance these factors and decide wisely.
• I took first NBME 13 online and scored 248. That was not a great score but I knew I did a lot of silly mistakes. So, I decided to place one more FA review in my schedule for improvements outlined in NBME.

October (First Aid 4th review + UWORLD 2nd round)
• I started 4th review of FA during September and supplemented it with a week more of biostats, ethics including 100 cases by Conrad, Khans 100 cases, it helped me a lot because this was the major weakness in my prior NBME.
• After completing FA 4th I took NBME 15 online and scored 250. I was in shock for a moment but reassured my self with the excuse that I made a lot of silly mistakes again. I would spend hours on researching ‘out of the blue’ NBME questions from Google, Wikipedia etc. But Biostats persisted the major weakness again.
• Well, I decided not to touch first aid until I am done with UWORLD 2nd round. I did UW 2nd round in timed random mode 8–10 blocks per day within a week. If you have done UWORLD properly during the first time you don’t need to do it again i.e one block per day over a month. Use it as an assessment and time management tool this time instead of a learning tool like
before. These 8–10 hours UW marathon made my stamina and tested my concentration that I would need during an actual exam. I found a lot of weaknesses like panicking in difficult questions, why I make silly mistakes, what kind of thoughts affect my judgment so I worked on those aspects specifically like controlling my thoughts about the result while solving vignettes, saving some time to review marked questions, avoiding silly mistakes. I tend to solve hard questions easily and most of my mistakes were easy questions.
• After 2nd round of UW, I took NBME 16 and scored 252. Both silly mistakes and biostats were major issues again.

November (First Aid 5th review + NBMEs + UWSA + USMLE)
• I started 5th and last review of FA in last week of October that continued until the last day before the exam.
• I took NBME 17 during FA 5th almost 2 weeks before the exam and scored 261. Since NBME 17 is easier one I thought it was over-predictive.
• Then I took NBME 19 around 8 days before the exam and scored 259. I have heard that NBME 19 in under-predictive but it was easy for me. I still made silly mistakes.
• Then NBME 18 around 4 days before the exam and scored 257, this time I wasn’t worried about the score because I was sleep deprived and I clearly made silly mistakes.
• UWSA 2- just 2 days before the exam and scored 269. I thought it was over-predictive. But it actually correlated very close to my score. On a side note, UWSA 2 is the hardest of all the
assessment exams.

Day before exam
• I reviewed all antibiotics because last micro review was a month ago. I did EKGs, heart sounds, MRIs and CT scans. I had to review biostats formulas but couldn’t do it because of exhaustion. I also did Free 120 (only tutorial) to get comfortable with test software. So, I left studying at 6 pm.
• I watched my favorite T.V show Friends, went out for fresh air, calmed my nerves.
• I fell asleep at 10 pm. Awaking at 12:30 with a panic attack. But I took control on the nerves with deep breathing exercise that helped me going to sleep again.
• I did not take any sleep aid like melatonin or benzo, because my metabolism is slow it takes more than usual time for me to wear off drug.
• Sleep is the most important factor determining your concentration and focus during the exam. I was lucky that I got 6–7 hours of sleep before my exam.

Exam Day
• I got up at 6 AM sharp. I prayed and took a light breakfast. And left for the prometric center.
• After all the procedures like signing papers, biometrics it was 7:30 AM. Examiner asked me if you want to start your exam right away before 8. So, I started my exam early and left the center at 3:30 PM sharp.
• I skipped the tutorial but used first 5 minutes to meditate before staring exam.
• I did 1st, 2nd block in a row, 5 minutes break, 3rd block was really hard, 5 minutes break, 4th, 5th block in a row, 20 minutes break, 6th block, 5 minutes break, 7th block.
• Exam was hard but doable. There were 4–5 out of the blue questions in every block.
• After the exam I had mixed feelings, at one extreme, I was thinking I aced the exam and on another, I was thinking I blew everything. You are never sure about how you did in the exam. So, just wait, trust your NBMEs and relax.

General advice
• How to approach out of the blue questions?
Practice, practice, and practice.
While doing such questions sometimes we get so hung up on a vignette on one perspective that holds us back to reach the right answer. In my experience if you just mark and skip the question and come back to it in the 2nd review round, you will have a new perspective of thinking, there are higher odds that you are going to figure it out this time. Most of such questions are easy and the answer is buried in details. Just practice keeping your nerves in control. I used to get frustrated like “WTH” by looking at difficult questions. So, I struggled a lot to keep calm and towards the end, I so practiced my impulse control that by looking at difficult question my first thought was “Interesting” Let’s figure it out.
• Do not let go of your schedule. Even if you read only one word, do it. But remember, you will always fall back in your schedule. So, don’t worry about it, just improvise, make a new schedule and go on.
• Do not withdraw yourself from daily fun in life. Stay focused and keep working but it does not mean you don’t deserve happiness. Treat yourself.
• Stay active, workout is very important for focus and discipline. If you are having a bad day, you have self-doubts, run a mile and then let yourself know: “if you can run a mile, you can do anything in your life” That’s how I used to keep myself motivated. I used to run 2 miles, swim at least 300 meters on alternate days. But I left work out only in the last 4 weeks.
• Never give up on something you really want. It’s difficult to wait, but it’s more difficult to regret.
• All the best for your future

Last but not least, I am thankful to the person who made all of this possible
My brother, my friend, and my inspiration, Hadi Javeed. He supported me emotionally, financially. He is my superhero. He used to take care of my daily meals and everything during the dedicated period. Without him, I would not be able to take this exam.

If you need to ask anything please do not hesitate to contact me. Maybe I can help you!
Thanks