Step 1 advice
The following is riddled with opinion, so what works for me might not work for you. Eventually, we
all find our journey. Also, the following might sound a bit extreme, but let me put it into
perspective for you. You are giving up your best years, paying (or someone is paying) >$150K to
get a license to practice, and you want to have as many doors open to you when the time comes.
MS1 and MS2 = Step 1. Two years = 3 numbers. Get your head in the game. Go. H.A.M.
As I write this, the nagging question is, what is your goal/who are you. I think there’s a fork in the
road when it comes to Step 1. You are in one of 2 crowds:
- You have a superb memory, have always crushed standardized tests -AND/OR- you have a goal
of scoring in the 230s, 240s - You have an average memory, work hard for your grades (99% of us) -AND/OR- you have a goal
of scoring in the 250s+ (ROAD + competitive surgeries, university IM, or you’re a DO who dared to
think about ortho )
If you belong to group 1, the standard doing well in MS1, MS2 + UFAP/Sketchy during dedicated
will be fine for you. I describe that more below, but you’ve heard it in most people’s post-Step 1
write ups.
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Group 2 is more interesting to me, because most of us aren’t geniuses, and a lot of us need high
scores to fulfill our dreams.
So, if you are in Group 2: Start from day 1 of medical school. I don’t mean read FA, that would be
weird. Avoid being weird. I mean do well in class, and start a spaced repetition program. Your
current choices are Brosencephalon’s Anki deck or Firecracker. You can trial either and see what
you like. The point is, you learned in genetics, in your first semester of medical school that amino
acids linked to tRNA come into the A position of the ribosome, then shift left, then form a new
peptide linkage, then exit etc etc etc. The problem is, the last thing you learned before your
dedicated period was Heme/Onc and the side effects of chemotherapeutics. You WILL forget
about how translation works. That’s just how your brain is. You never demanded it to remember
how translation works after you took your genetics block test. So don’t blame your brain, blame
yourself. The solution is a spaced repetition flashcard program.
I used Firecracker, you can use Brosencephalon, or better yet, create your own Anki deck as well.
It takes 1-2 hours a day. It seems mindless and you will want to quit every now and then, but,
having done all of this, I can say without Firecracker I would have scored 10-20 points less. If you
are already an MS2 right now, there isn’t enough time to do this, that is fine, just focus on
UFAP/Sketchy. If you are an MS1 or are 12 months from your exam date, I highly recommend this
approach.
Now, in terms of materials:
Firecracker/Bros/Anki: Your spaced repetition if you have time etc
UWorld: Live and die by this QBank. Better questions have never been written. Do every single
question, and thoroughly read every explanation. Keep a UWorld notebook. I ended up filling our
never convince yourself ‘they would never ask that on the real deal.’ Wrong. It’s their job to ask
that on the real deal. Make yourself want to know the what and why of everything. Browse
Wikipedia if you have to. Just know why. That’s your job.
Kaplan Qbank: I recommend this Qbank. Lots of annoying questions and details, and guess what,
that matters on test day. Sure it’s not the highest yield. So, do this Qbank before UWorld if you
have the time. I did ~800 questions.
USMLE Rx: Medium and hard questions are useful for content review. These questions are never
really challenging. If you have time, you could use it to quiz yourself on weak areas. I did ~800
questions.
Sketchy Micro: Great program if micro gives you trouble. It has everything First Aid has. If you
need it, do it. Definitely worth the time. I only used it for a few viruses, and apparently did well on
micro, so you who knows.
Pathoma: Listen to every word this man says. Multiple times. You should hear him in your
dreams. This is a good thing. Remember, this is high yield for examination purposes.
FA: Use it to review and reference. It’s a really boring read. Doing questions is key. If you did
spaced repetition, you will eventually have memorized all of FA.
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Timeline wise: if you are Group 2, you do spaced repetition, then when you get to dedicated, do
UFAP/Sketchy. Add more questions, like Kaplan Qbank before dedicated if possible. Group 1, do
well in class, do UFAP/Sketchy during dedicated.
Practice tests: you can do a baseline NBME if you need to. I’m not a fan of doing an NBME every 2
weeks. What does it tell you that UWorld can’t? UWorld tells you your weaknesses. I think NBMEs
should be saved for the last 2 weeks. You need to learn how the test writers ask questions. You
also need time to adjust using your knowledge on NBME exams. This includes learning to trust
your hard-earned knowledge.
UWSAs are good too. They are basically more UWorld. People say NBME or UWSA is more
accurate. I think it comes down to which batch of questions you get on your test day. If the
questions play to your strengths, you will say NBME or UWSA is more accurate depending on
which you scored higher on and vice versa.
Test day: It’s super important that you are in game mode on test day. Remove any crap from your
mind. Forget about everything. (If you’re a Falcons fan, don’t think about the SuperBowl). Just be at
peace and preserve your energy. I took USWA2 the day before, but if you can, avoid that. Maybe
just leaf through FA the day before, whatevs. Take breaks on your exam, pace yourself. You will
feel tight on time, so make sure you learn to test efficiently when you are taking practice exams.
The MOST important thing here is, just trust yourself. Yeah, they can ask you about some random
BS about some disease that 4 people in Borneo get every year. Don’t get phased by that. The
concept is always something you have learned. Every question relies on a basic fact or mechanism
that is in FA. Mentally, after reading a question stem, ask yourself, okay, what do these tools want
from me? Then deliver. Deliver to the tools.
Scores:
NBME 15: 255
NBME 17: 250
NBME 18: 252
NBME 19: 255
UWSA1: 262
UWSA2: 269
UWorld average: 84%
Free 120: 93%
Real deal: 260