First of all, I needed to say something. In the measures of USMLE I’m considered a very old graduate. So my experience is for everyone but I hope it creates some difference for older graduates. My YOG as everyone likes to name it is 10 yrs now and for several reasons related to safety and security back home I had to leave and relocate to the states less than a couple of years ago. Then few months later started the journey of USMLE:
I will detail what I did to prepare and after taking the test and results what I believe I should have done to prepare:
STEP 1 (STEP 2 will come in few pages so skip to it if not interested)
PREPARATION TIME: Nov 2014-October 2015 (~11 m) Exam 10/22 results were on 11/11/2016 – 257 Materials: 1st run KAPLAN LECTURE NOTES+VIDEOS: 4.5 m (All Kaplan 3.5 month except Pathology-1 m alone) in this order and if I went back and studied I wouldn’t change anything in this first run: Physiology: must do Kaplan covers concepts elaborately (BRS or High Yield good too but I liked Kaplan, FA is very weak in this area compared to the others and my test q had lots of weird physio q). Kaplan Physiology videos in my opinion are not so good and can be skipped.
Anatomy: Kaplan is very good in general, videos are amazing and so simple. FA the latest version is getting so close to cover the most imp materials as well, would have read FA anatomy if I am using FA2016.
Neuro: if you like to understand it well then Kaplan + FA + Pathoma. if you need to push this exam then FA and pathoma are good enough. Dr Najeeb on youtube is amazing too but soooo long.
Biochemistry: Kaplan is very good, videos for me were very very useful but very lengthy. FA is kind of confusing but has so many good tables that cover all the essentials except for metabolism which is very weak in FA. You have to mug it up from FA while with Kaplan you tend to understand and analyze. the molecular part is good in Kaplan. Genetics are good in FA.
Microbiology: Kaplan book and videos are mediocre. FA is great for those subjects especially the 2016 version it covers them very efficiently.
Behavioral: Kaplan book is good, especially after adding the patient safety section this year and the videos of Dr. Daugherty are good but damn does he try to confuse you or just make you understand things in a painful way.
Pharmacology: Kaplan book amazing. Videos are priceless. Lionell is a super simple sarcastic instructor yet breaks down everything to you to make it easily digestible instead of swallowing it dry. FA is as good but I did not use it at all and would still stick to Kaplan.
Pathology: I used Kaplan book, very good material but super messy, if I go back I would use FA. For Videos Pathoma is amazing no replacement for it. Pathology took one month to finish the first run
2nd run KAPLAN LECTURE NOTES+VIDEOS: 4 m similar to the first run plus KAPLAN Q BANK starting with Patho and Pharma q blocks-timed then adding one subject at a time as I was reviewing the lecture notes again. I finished 80% of the bank but if I went back I would not finish more than 50% as q tend to repeat a lot and I may finish all the physiology, biostat and patient safety together with pathophysio q instead of the whole bank.
Repeated Patohma videos as well when I reached patho again.
The best thing about Kaplan Q bank is that it refers you back to the subject or concept page in FA which makes it super simple studying Kaplan with FA and this is how I used FA as I never went through the whole book by itself. also this way saves some time and make the short condensed FA material easier to digest. If I went back again I would change the following in the 2nd run:
No Immuno-Microbiology Kaplan only FA or sketchy micro.
No Biochemistry revision only UWorld biochem q because they are so good and very close to the test.
Except for the molecular which is a must in Kaplan and FA. During the 2nd run I discovered the presence of DIT and I watched lots of them during the revision and While doing Uworld. If I knew about them earlier I would have not watched any Kaplan videos in the 2nd run (except Pharma and Gross Anatomy) as they cover FA plus some extra stuff. and also visual + audio + written study material further reinforces your memory and understanding so I consider them golden and they definitely replace Kaplan if you have a tight preparation schedule.
After that I took NBME 13 my result was 239 and felt confident to start U world and take the test after.
UWORLD: 2 m plus few days amazing q bank. You add tons of notes, and because I was already done with most of the materials I took the whole bank timed and random marked q as I was going through and I finished almost 94% or a little bit less. During this period I went through DIT videos related to the q that I get wrong or just to see their explanation of those subjects.
The overall performance of UWORLD and the percentile were extremely similar to my score. I was on the 93rd percentile and the overall was high in the 75-77 area cant remember exactly.
Last month : I reviewed some subjects in FA and Kaplan extensively (one system every 1-2 days) then took NBME 15 and I was really tired and scored 234 and felt like there must be something wrong. I pushed the test 2 weeks ahead and started reviewing Uworld marked q slowly with no pressure, did not want to do any further assessments and my test was a mixture between Kaplan q bank and U world and lots of familiar concepts in difficult qs but very very doable .
STEP 2 CK&CS CS Exam 01/25/2016… CK Exam 06/14/2016 results 07/13/2016- 260
this is a beast. I don’t care if people say that step 1 is harder. for me step 1 is like a kids game compared to step 2, step one is about the magnitude of material you get exposed to and the understanding of general ideas, step two is all about details and mastering concepts through memorization as most of them are evidence based and may not always be logical (i.e. research shows benefit in this age but not that age which is something you can’t just reason out you have to know it and swallow it dry. and so on)
PREPARATION TIME: total CK and CS Nov/15/2015 to Jun/14/2016 ~8 m total
Divide this period into 2 parts: November/15-end of March 4 hrs study/day
April – June/14 10 hrs /day
Study Material: KAPLAN: Medicine: 1st book finished in 1.5 months, watched very few videos. it is good but during my preparation period I had the pdf versions of Step up to Medicine, MTB 2/3 and FA. and used them to search some subjects when I felt like more explanation is needed. 2nd book OBGYN: studied that book for a month and few days together with USMLE CS (overall took between 2-3 weeks and was done in LA which is similar to Houston or any other center and the IMG friendliness of Houston center is a myth, everyone I know took the test in LA passed).
After CS I finished OBGYN and then surgery book which is good, short and concise.
I had the books of pediatrics and Psychiatry/bio and epidemiology but did not specify any time to read them I immediately started UWORLD and went back to those books when I get a related q to add notes and review those subjects. And at this point I must say that the biggest part of preparing to step 2 is finishing step 1 right before that, it makes your life easier and covers the following aspects of step 2 automatically:
Pediatric genetic diseases 85% Hematology 75-80 % Dermatology 50% Opthalmology and ENT 50% Endocrine 40% GIT 20% Cardio 35% Renal 50% Biostat and Psychiatry 60-65% Rheumatology 35%
So you can see obviously that it shortens the period of preparation and it also covers most of the patho q you might face in the test(which is probably one or two q per block)
Up to Date: an amazing source, did not use it very consistently. I would suggest you use Up to date every time you answer 2 q with a similar concept wrong. which means clearly you need more details about that concept. the other time you use Up to date is when you see a q or an idea on the group that you don’t know and can’t find in the available review material-provided that this idea is relevant to the test-
Step up to medicine: too detailed but the best one available for medicine.
MTB 2,3 : it is OK, didn’t read more than 10% of them and did not feel like it gives you the range of understanding needed for step 2, on the contrary it keeps telling you that if you see this in a q then choose this as an answer which oversimplifies the real qs. and can be very misleading sometime so I did not touch them overall.
FA: I think the new version which I got late in my preparation and studied very few subjects from is just a mediocre version of Uworld explanations + MTB so overall not really reliable.
UWORLD: no need to say what this q bank means to this test. The tables and algorithms are great for sure and even more important the explanations which makes you differentiate between one case and the other.
I started Uworld FEB/15 – Jun/14 3.5 m total. mostly were timed, unused and combined full 44 q blocks(did it one time for right q and repeated only wrong q and the marked(correct) ones both totaled at 600 –this makes you focus on the difficult concepts instead of repeating everything all-over again just to save some time-)
Finished the 1st 40 blocks+studying their explanations and writing down everything I can. and my overall performance was 76%. And I marked lots of q to review later. Finishing on time was a difficulty.
After that I reviewed the books and notes quickly(15 days for medicine, 7 days gynecology and few days surgery then few days pediatrics and again no big psychiatry/biostat review (which is a big mistake)
Then started creating blocks of wrong q - system wise- it helped me clear lots and lots of concepts and scored very high in those and read the explanations again.
The last 30 days:
I started the last 30 days by taking the remaining 10 unused blocks timed and combined again. this time my overall was 85 % and I knew that I was almost ready and thought of taking NBMES after that just to get some exposure to their style but not to rely on them because of my bad experience with them in step 1.
So, I took NBME 7 online 2 weeks before the test and I scored 254 (24) wrong q then studied the whole test for new or additional ideas using UP TO DATE. The q stems of NBME 7 are ridiculously short and useless assessment tool. but good for new ideas.
After that I did 2 CMS blocks (3,4) of medicine/pediatrics/psychiatry/OBGYN/NEURO but did not take surgery(no time) and looked for explanations either via the volunteers who made them for the group(myself was one of them, I did CMS OBGYN 4 and it boosted my performance in GYNE) or on the other CMS and NBME group.
CMS: my input on them is as follows:
Psychiatry: highest priority, just do them all as you will definitely see similar q in the real test and I wish I did them all as I suffered with psychiatry.
OBGYN: I would say they come after Psychiatry and definitely do them all.(may be because I was not very good in this subject)
NEURO: comes next to OBGYN because it has some crazy concepts and some difficult q that you won’t see anywhere else.
Medicine and Pediatrics: they were the easiest and were not as important compared to the above mentioned ones. Yes you may find few new ideas but in general they are almost covered by UWORLD
Surgery: unfortunately I haven’t done any of them but ironically my surgery performance was the highest in the test report.
Took UWSA 8 days prior to my test and got 260(ONLINE). It is by far the closest one in length and to a certain extent to the quality of q in the test(my test at least) then reviewed the wrong ones and quickly the right ones as well.
Then reviewed the Kaplan patient safety materials and the U world biostat. they are very good but unfortunately I did not get any related q in the real test.(I reviewed this material while reviewing the NBMEs)
Then took NBME 4 4 days before the test and scored 263-5 (I had 13 wrong q and I compared the results to people took this test online having almost similar wrong q) and reviewed this one very quickly as it was easier than NBME 7 but the q stems are closer to the real exam(although they are still far away in difficulty and length)
Notes and Test day:
What follows now is totally subjective and different from person to person but…. I slept well the day before the test, went confident as most of those who took the test said it is UWorld plus some difficult q and lots of direct q. to be honest I was totally shocked in the 1st block when I felt like I really can’t be sure of any of my answers, I was running out of time, couldn’t finish all the questions and left 2 fairly easy q unsolved in the first block and 1-2 unsolved in the 2nd and in a moment I felt like I should just
leave this test and go because I didn’t think I will do any better in the upcoming blocks. Really really long q stems, extremely difficult and close “next step” choices which leaves you clueless and you may start guessing in an embarrassing way. Then the rest of the blocks kept being difficult but I started solving faster, don’t think a lot and if the stem is extremely long I just jumped to the next one immediately.
With all that being said, I do not want to make you scared or depressed but to show you that the calculation of this test is far away from being straight forward and I do believe(no basis for this though) that they compare percentage and run analysis of answers in similar periods between different students, otherwise I don’t think I did that well in the test based on right and wrong q alone. Other issues: take rest after every block, because if you survived the first one and started the 2nd immediately there is a good chance that you run out of brain neurotransmitters midway in the 2nd one(I don’t know a scientific reason here).
Take the first minute or two to check your headphone and don’t skip introduction immediately because I had to restart the test and move to another station because of that. And you do not want to miss the audio q because they are the easiest compared to the whole madness.
NBMES and UWSA scores were extremely similar to real exam score, but honestly they are no match, not even 60% in length and difficulty to the real exam.
If you haven’t taken STEP1 and still need high score then you need to significantly extend your preparation time(may not apply to people who were in medicine or just graduated with good medicine background).
Videos in step 2 preparation are not as useful as step1, I found that MEDED is good but again not so essential.
Things I could have done better: 1. Take NBME 6 early(1.5-2 months before test day) to check my performance. 2. Finish all CMS forms(not so essential but useful) 3. Do UWORLD step 3 q(I solved like 40 q of them then said I do not have time and stopped, judging by my score they are not really of big importance but if you have time or your performance is not improving it might be a good idea to take them). 4. Read step up to medicine and place all UWORLD tables and notes on it. 5. MKSAP q: although not really important but they won’t hurt especially that they have explanations to their answers. I did few and stopped. 6. Take FRED test(I think it was a big mistake not taking it). 7. Taking UWORLD system wise. I made a very bad decision not taking at least half of them this way because it would have helped me compare and contrast different ideas and concepts of each system. so if I go back I will still do them timed but system wise instead of combined and will leave around 30-40% of each system unsolved just to train my brain to go through timed and combined q at the end.
I humbly wish that this experience would help someone else taking the steps as the experience of other people helped me. Find your comfortable schedule. Don’t stick to a stereotyped plan as everyone is different and what might work for me may not work for you, share ideas share questions and search for answers and do not always take them for granted from other people.
Everyone has his distractions. Most of us have enormous other responsibilities and personal issues which may push your preparation time in a way or another but should never drive you to quit.
Good luck guys and wish you all wonderful scores.