USMLE Step 1 Experience – 262 –American Student
I wanted to share my experience in hopes that it will help some others who are still fighting the
good fight. This thread helped me a ton in prepping for this test and kept me motivated in times
where I was feeling pretty down about all the studying.
I also want to preface this writeup by saying that I am a very average student by what is
considered for a U.S. medical school applicant; I attend a small medical school that is primary care
focused and is ranked somewhere around 100 in terms of annual NIH funding for research. I had
a 31 mcat and feel lucky that I even got into medical school. I also know plenty of other people
who had mcat scores less than 30 who destroyed this test. Natural intellect and a strong history of
doing well on standardized tests is not what is necessarily needed to do well on this test–Step 1 is
a test that rewards those who work hard. If you grind it out and actually learn your basic sciences
well in the first two years of school, this test will reward you for it.
Resources: First Aid, Pathoma, USMLE Rx, Goljan Audio, UWorld, and ?DIT videos?
well will ultimately be the best preparation of all for doing well on this exam. Many students do
not realize this until it is too late, and waiting until the last semester of 2nd year to prepare for this
test is simply just not enough time to cover all of the information you’ve learned in the first two
years. Additionally, when you start doing questions in the qbanks you will be shocked by how
often the only reason you are able to answer some of these questions is by recalling or
recognizing things from your classes, because all of the info is NOT covered in the review books.
With regard to resources (other than Rx and Uworld), I believe that the Goljan audio and Pathoma
were key to my success. Some people say that Goljan audio is outdated and too old to worry
about using, but I swear that dude’s audio recording was freakin gold for me. It is ridiculous just
how high yield it really is. I never sat down or took time out of my classes or pathoma to listen to
it, but throughout 2nd year I routinely listened to him when I was driving or on a flight or anything
where I could get a solid 20-30 minutes at least of listening. Some people recommend listening to
him in the gym, but depending on what you call “working out” I would advice against this.
Passively listening to Goljan is a waste of time; you need to be able to listen and pause regularly to
answer his questions and stay actively engaged in the lecture. I was seriously able to probably
answer between 5 and 10 very challenging questions on my exam thanks to that audio, and many
other straightforward questions
terms of prepping for this exam. I used this book as my primary means of actually learning
pathology, and then I would go through my school notes once or twice prior to the exams just to
memorize enough to do well on the test.
DIT: unless you have time to waste, I wouldn’t bother. I went through some of the videos but most
of it was pretty superficial. I would use it for areas you feel your school courses were weak in, or
areas that you are struggling with. I just had some of the videos, not the big workbook and all that
stuff.
USMLE Rx: I ended up completing 68% of the qbank with an overall end average of 74%, with a
predicted score of 261 +/- 20 for the 95% Confidence Interval (It happened to end like this, but be
aware that my “predicted score” typically fluctuated anywhere from 242 to 262). This was done on
total random for the large majority of the qbank. I did a few blocks before the micro shelf just
strictly on micro. I always did blocks on timed mode however. When I started the qbank, my
averages were typically in the low 60% area, sometimes getting down into the mid-low 50s, and
every now and again I would hit around a 70. By the end my run with Rx, I was averaging high 70s
and sometimes low 80s, and only occasionally getting anything below a 70%. As many have stated,
I would recommend using this qbank along with FA, and the two should basically be a single unit.
For me, reading FA was a total waste of time and I pretty much never just read FA alone. 95% of
UWorld: I only ended up doing 70% of the qbank, and did every single block in timed random
mode. My overall ended up being an 83% average for Uworld, and it really didn’t fluctuate much
from when I started the qbank. I think after my first 10 blocks my overall average was 80%, so it
only ended up coming up a few percentage points. I largely attribute Goljan and Rx for the reason
why I was able to come into this qbank and make decent scores from the beginning. Uworld really
is an amazing qbank and I wish I had more time to have finished it.
Overall, the golden ticket is this: UFAP + Goljan (do NBMEs to tell you where you are score-wise)
Practice exam scores:
NBME 13 (~6 weeks out): 258
NBME 15 (4 weeks out): 249 ßte fuq?
CBSSE (given by the school 4 weeks out): >260
UWSA1 (3 weeks out): 260
NBME 17 (2 days before step1): 260
STEP1: After all the horror stories I heard about the test, I was sure I was going to get in there and
it was going to be an insanely challenging, long test with huge stems and tons of data and graphs
everywhere, but it wasn’t really anything like that. My test overall felt like a mix of uworld and
nbme exams. It really wasn’t THAT bad. At least half of the Uworld blocks I had taken felt harder
than most of the blocks on my exam. Some questions were extremely straightforward first-order
questions, and some I literally had no clue on and just had to guess. If I could break it down for an
average block I would say that about 20 questions on each block were pretty straightforward and
as long as you had been an average student you would probably answer most all of these
correctly. Another 15 or so required a bit more integrative thinking or required some little detail
you had to know in order to answer the question, and then another 5-10 were pretty tough and I
basically had to completely guess on anywhere from 3-5 of these. The biggest challenge I faced on
my test was the ambiguity in the questions or answer choices. It was exactly like NBME practice
tests on so many of the questions; you know the disease they’re describing, you know the
pathophys behind it, and you know how to treat it, but then the way they phrase the question
kinda leaves you thinking “well wtf do they mean by that”? Or, if its not the question, you look
down in the answers and you swear that 2 or 3 of the answers are right, and then you basically
end up blindly picking between two. Unfortunately it felt like this was happening pretty
consistently throughout the test. You could easily narrow the answers down to two choices, but
from there you just had to go with your gut. So despite knowing the majority of the diseases and
pathology behind them on each block, I still on average marked like 15-20 questions per block,
and almost never had the time to actually go back through all of them. I do want to also state that
I tend to mark a LOT of questions in general; on Uworld for instance I routinely mark around 10-
12 questions per block.
Additionally, the ethics/patient interaction bull**** was honestly some of the stuff that bothered
me the most my test (luckily there wasn’t just a ton of it). Half of the answer choices sounded
correct, and I just had to guess. It was not a comforting feeling at all. I also had 2 or 3
epidemiology questions that required graph interpretation and I was never able to figure out
exactly what was going on and had to guess. When I left the test center, I felt confident that I
passed the exam, but I still felt sick to my stomach because it seemed the score could basically
end up anywhere from a 220 to a 270. I tended to feel this way after the 3 NBME tests I took as
well, so I was just hoping everything turned out ok and was at least somewhere in the vicinity of
my practice test scores. Overall, I want you guys reading this to realize (at least from my
experience and others I know) that the test will not be that different from things you’ve already
seen. Trust your uworld scores and nbme exams. Just about everyone who takes this test uses
those resources too, so your percentile on uworld and scores on nbme exams will likely correlate
pretty well with how you will do on the real deal. Best of luck to all of you.
Took Step 1 on June 15– actual score: 262