USMLE Step 1 experience - Mohammed Qussay Al-Sabbagh
I’m Mohammed Qussay Al-Sabbagh, a 6th
-year medical student at the
University of Jordan, and I have recieved my Step 1 results a few days ago,
which’s turned out to be 263, Alhamdulillah! Thus, I have decided to note down
and share my experience, as I found reading others’ experiences very useful to
me…
This experience documentation will be divided into three sections; general
take home messages, my USMLE step 1 journey, and my studying sources.
I. Big misconceptions
“Just because everybody does it, doesn’t make it right”
In this section, I’ll present some big misconceptions about Step 1
preparation, which drives students to be needlessly worried, rendering them
unefficeintly anxious and distressed at all times. Before starting, ALWAYS
REMEMEBR that there exists no schedule or technique that fits all kinds of
medical students, which calls for the creation of your own personal approaches
according to your own capabilities which no one knows for exact except for
yourself!
Misconception #1: “You won’t get a high score without reading FA and
UW at least 3 or 4 times!”
FA and Uworld are amazing and competent resources, so competent, most of
my exam came directly from these resources. However, there’s no point of
repeating something you’ve already know! This especially true for UW. Despite
the fact that the actual exam is identical to UW in terms of style and apparence,
you’ll never encounter a question that is copied from UW.
UW is a great training tool, its sole purpose is to be used in order to develop
exam-taking approaches and strategies. Your intial impact with UW and its
associated questions will provide you with enough information for you to develop
exam-taking strategies, however, that happens only once as your reruns of UW will
be nothing but a subconscious memory indurance test of familiar questions and
contexts. Some may argue that the knowledge embedded in UW’s questions are of
high yield quality and needs to be memorized by heart, this is partially true, as you
can review and re-examine such information from your self-generated notes and
flashcards without the need to waste time and effort going through a huge testbank.
Actually, If I had more time, I’d do another test bank like Amboss or Rx.
A. Misconception #2: “Never take your exam until your assessment scores
are within your target.”
The circumstances and the surrounding environment in the real exam differs
a lot from your home environment. Moreover, no one knows the exact questions’
percentages and scoring systems that shall be used in the real exam. So there’s no
point of using assessment exam scores to predict your performance in the real
exam, then ultimately start developing anxiety instead of re-evaluting your
studying strategies and subject-specific weaknesses.
Perosnally, I have never used online NBMEs and did not even finish all of
the offline ones. In addition to that, I have never done any assessment exam in the
ideal conditions, as I have used to take my assessment exams under conditions
where I was either tired, sleepy or ‘fasting’ (its noteworthy to mention that most of
my dedicated study period was in Ramadan).
Does this mean that assessment exams are useless?
The answer is no! They are very good tools to assess your relative
weaknesses and strengths, with which you can polish your skills in areas you’re
competent in and re-examine areas in which you have a significant knowledge
deficit, however, don’t rely on them to predict your performance and score for the
reasons mentioned above.
B. Misconception #3: “You have to skip your classes or rotations and
sacrifice your GPA to have a good score in USMLE.”
Although this statement might ‘sound’ true, yet it has little to no
authenticity. Simply because the USMLE step 1 is clinically relevant/oriented, and
the more clinical experience you gain, the more you understand, memorize and
develop concepts. Most of my actual study period was during the second semester
of the 5th year. (For those who are not familiar with medical school curriculum
here, this is the busiest semester in the faculty of medicine, where we have a
different rotation every two weeks, with all of its exams, seminars and on-calls.)
Although this was very stressful for me, I enjoyed it! As interacting with
people every day, dealing with patients and hanging out in the university grounds
reduced my anxiety and alleviated my burnout, thus USMLE Step 1 preparation
became a part of my daily routine.
II. My USMLE journey
"It’s not what you do, it’s how you do it”
As I have developed insight for the gravity of the USMLE, I tried to make
USMLE a part of my usual studying schedule in an effort to disseminate the
burden of Step 1 equally all over the last 5 years of medical school, to the point
that Step 1 has become a part of me, and I have started to feel empty after finishing
it.
In general, my USMLE journey could be classified into three phases:
A. Gaining knowledge (1.5 years)
As I mentioned earlier, I tried integrating USMLE Step 1 in my regular
studying schedule over my basic and clinical years. Such mindset led me to use
various USMLE-centered resources like Pathoma and Kaplan instead of disorinted
sources of information.
After finishing my basic years, I analyzed my weaknesses and found out that
I had very bad basics in Pharmacology, Microbiology and Biochemistry. Thus, I
studied these topics in depths during my vacations (Pharmacology and
Biochemistry from Kaplan’s videos and Microbiology from Boards and Beyond).
During my clinical rotations, I studied each rotation’s correspoinding body
system from FA, so that I could integrate clinical knowledge within its ‘basic’
context. At the end of each rotation, I used to solve old offline UW questions in
order to have an idea about the real-life applications of such knowledge. In this
way, I was building a very strong foundation for Step 1 while keeping my GPA
unaffected. This period ended in the middle of the 5th year, where I’ve finished all
the four clinical majors.
B. Actual USMLE preparation (3 months)
At 1/1/2019, I decided to start my real journey, I made a schedule and tried
as hard as I could to stick to it, and fortunately, I succeeded to achieve such fate!
I started to study FA while addressing my weak areas from high yield
resources. In this period, I have subscribed to UW and allocated only one hour per
day for its usage. Morevoer, I started to use Anki flashcards for Pharmacology and
Microbiology with an average use of 30 minutes per day. 3 months thereafter, I
finished all the systems and topics, with 60% completion of UW. Yet, I had to
postpone my actual preparation for one and a half months due to finals. (It should
be noted that i did some offline NBMEs in this period).
C. Dedicated study period (6 weeks)
After finishing my finals, I was really burned out and tired, and to make
things worse, most of my dedicated study period was in Ramadan, when I was
fasting most of the day, and was unable to sleep or study. However, I pushed my
self to the limit and tried to study in every single available moment. In this period
gave 2 hours daily for Anki, and 4-5 hours to memorize FA and 3 hours daily for
UW. (It should be noted that during this final read of FA, I recorded any piece of
information I find difficulty in, syndromes, or equations in a notebook and revised
it daily, thus I created my personalized “Anki” and ended up memorizing the FA).
It was a very harsh and stressful schedule, and I had many burnout blows
and stress episodes, but I knew how to manage them and make the most of the
avalible resources and this is where this very important take-home message appear;
You know the dimensions yourself better than anyone. One of these demensions is
your stress-taking threshold, this means, always try to create a schedule that isn’t
purely in your comfort zone and isn’t a hellhound imbedded with unhealthy stress.
I finished UW and this final FA read in about 4 weeks. In the next 2 weeks, I
did a lot of assessment exams, revised NBME images, and read some
miscellaneous material from USMLE groups in attempt to train myself for whats
upcoming.
Three days before the exam, I did the free 120, then revised some high yield
points from FA and my notes.
In the last 2 days, I followed dirty USMLE video recommendations
(https://www.youtube.com/watch?v=zJgjMZk8_To&t=2s), and surprisingly, I slept
well the night before the exam, and never had caffeine withdrawal headache! This
video is gold!
D. The day of the exam – A.K.A the real deal:
I reached the exam center at 7:00 AM and started the exam at 7:20, I
finished all the blocks in 35:00 to 40:00 minutes, and took a break after each block
to eat protein bars, drink water, and pee.
In general, the exam was in the style of UW. I’d say 80% questions were like
Uworld. In terms of information, 90% was mentioned in FA, Uworld, and
Pathoma.
The exam depends on understanding and comprehension more than
memorization yet both are necessary. I’d say 70% of the exam was doable, 20%
needed deep thinking and linking of different concepts. (From my experience, no
weird syndromes were tested as most of the questions were atypical presentations
of very common and easy diseases, so if you read the question carefully, you
would figure out the answer). Finally, there were the10% of questions that are
very weird per se that required the memorization of some weird image or bizzare
concept, however, you can answer most of them by exclusion.
I marked 2-3 questions in each block. Moreover, the most useful thing I’ve
done is doing UW with random-timing as that practice made me feel that I was
doing an average difficulty Uworld block during the exam.
Pharmacology, Biochemistry and Microbiology were straight forward and
are really guaranteed points/marks if you studied them well. Most of the pathology
and physiology sections were doable. However, I did face 5 questions that were
very tough and weird in which they tested weird associations between pathways.
In terms of anatomy, it tested multiple concepts and ideas, but most of the
questions were easy to answer if you have good basic knowledge/foundation.
Biostatistics was tough but doable if you’ve understood the basic concepts well
from the Uworld review, which is enough for Biostatistics. Ethics was centered on
doctor-patient relationships and other family-medicine centered topics. I’ve
answered 50% by logic, 25% from family medicine rotation experience and 25%
by educated guessing. Finally, the exam had 10 to 20 questions testing
unanticipated concepts such as basic ideas from pathology and basic biology (101),
and some clinical CK-like concepts.
My general impression is that the exam was fair and easy. Which is bad
actually, as missing some basic questions may miss up all your score, so
concentrate on basics of pathology, pharmacology, microbiology, and biochem,
any small mistake could be fatal! If you are aiming high.
III. Study resources
In general, there are multiple excellent study resources out there. You can
use whatever works for you, but don’t distract yourself with multiple resources.
Use one resource for building concepts and a summarized resource for
memorization. Never ever attempt to go the exam without mastering the gold
standard: FA, UW, and pathoma. This is summery of what I’ve used:
- Biochem: Kaplan 2015 Dr. Turco (to build concepts) + FA to memorize.
- Immune: I had a very good basic, so I used FA alone ( B&B is good as a
good source) - Micro: B&B (to build concepts) + Anki flashcards to memorize.
- Bistastoics: UW review.
- Ethics: Kaplan 2010 videos for (ethics and doctor-patient relationship)+
FA+ 100 cases by Conard fisher. - Public health: Kaplan 2018 behavioral sciences textbooks (the last two
chapters) - Pharma: Kaplan 2010 Dr. Raymond (to build concepts) + ZAnki flashcards
- Anatomy: I read HY anatomy and neuroanatomy quickly 3 months before
my exam, then revised FA+UW+100 concepts in the dedicated period. For
neuroanatomy, I watched B&B as well + ZAnki flashcards. - Embryo and Histo: FA alone.
10.Physio: FA + UW (more than enough, but you have to master it well), I
used BRS and B&B to understand some topics.
11.Pathology (the most important, 70-85% of the exam is pathology and
pathophysiology): Pathoma+FA, I revised some pathways from robbins as
well.
Note: Anki and B&B are amazing resources! if I’ve decided to start from scratch
in the 5th year, I’d do B&B along with FA+Anki for memorization alone. I think
these resources are enough.
And finally, these are my assessment scores for those who are looking for
predictive values:
Offline NBMEs 13: very early in my study, 23 mistakes (which’s something
around 240-245)
Offline NBMEs from 15 to 19: from 5 to 14 mistake (between 250 and 265).
Offline NBMES 20 and 21: 25 and 23 mistakes respectively (around 255).
UWSA 1: 271 (before the dedicated period, after finishing my last final exam
directly)
UWSA 2: 269 (3 days before my exam)
Free 120: 92%
UW 1st time (random, timed): 89%
Real Exam: 263