He shares with us how she scored 267 on the USMLE Step 1 Exam

Dr. Priyanka Lakshmanan
He shares with us how she scored 267 on the USMLE Step 1 Exam. Her in depth USMLE Step 1 experience will answer your questions of how to score 265 + on the USMLE Step 1.

I am an IMG from Mumbai and took my Step 1 currently in my 3rd year of med school (2015).

So I went over to a counselling center and enrolled myself for the Kaplan courses (center prep) in the year 2013. I started the lecture series in the year 2014 as I had to wrap up some stuff prior to that.

By Aug 2014 I was pretty sure of wanting to give off the exam in the year 2015. I visited the center almost 2-3 times a week. I would sit for 3-4 hours at a stretch and do the lectures.

By the end of 2014 I was done with most lectures except Behavioral sciences and parts of biochemistry, pathology, physiology.

What I covered from Kaplan courses

  1. Behavioral sciences: The whole thing. Found it extremely useful. Dr Daugherty is an amazing professor and clarifies stuff amazingly. Did the lectures for chap 1 and 2 twice.

  2. Biochemistry: All chaps once.

  3. Pathology: Covered the whole of systemic. Did only neoplasia from the general path section.

  4. Pharmacology: Again all lectures. Did the lectures for the volatile stuff like ANS and anti-arrhythmics twice.

  5. Microbiology: All lectures once.

  6. Physiology: Just CVS, Renal a bit of respiratory physiology, the whole of chap 1 (fluid distribution), nerve and muscle physiology.

  7. Anatomy: The whole of anatomy except neuro anatomy. Histology lectures were a waste of time. Did anatomy as my last subject because it is extremely volatile.

Materials other than Kaplan that I used

  1. FIRST AID FOR THE USMLE (LATEST EDITION) – Practically the bible for step 1.

  2. BRS for physiology : Very concise. Would recommend only if your basics are strong.

  3. High yield neuroanatomy : Again extremely concise and volatile. Good for the neuroanatomy stuff tested on step 1. But again your basics have to be strong else you find yourself reading your base book every now and then (happened to me).

  4. Dr Najeeb’s lectures: OK! SO this one is MASSIVE!!! Concepts cleared BEAUTIFULLY!!! The lectures are amazing. Unfortunately, I found out about these extremely late during the course of my preparation. So did a select few chapters of physiology (renal and respiratory), neuroanatomy (a few lectures), ECG.

  5. Goljan for pathology: The whole thing once. (every single page) Revise chapters like skin, musculoskeletal. (These are tested very frequently on the exam).

Books I would advise if you have time

  1. Robbins and Cotran for pathology.

  2. Clinical Microbiology made ridiculously simple.

  3. Katzung basic principles for pharmacology: The chapters on pharmacodynamics and pharmacokinetics.

Question Banks

Kaplan Q Bank
U World
NBME FORM 15, 16, 17. (Have heard that form 13 is a good predictor of your final score. But an average of all your u world and NBMEs is a better estimate rather than one single test).
Study Period

7 months intensive preparation


I had started doing the Kaplan lectures and taking down notes into the Kaplan books since May 2014. Since I had to manage other academic and extra-academic stuff with it, it went a little slow.

Nevertheless, I managed to complete most of the important subjects (except physiology) by the end of Jan’15 (the year of my step exam).

Annotate as much as you can from the lectures. It is better to be thorough in the beginning rather than incomplete later on. It takes some time but it is worth it in the end. Serves as a good reference book once you start solving the tests and you need to get a few concepts clear.

PHASE 2: January ‘15 – June’15 (First week)

This was a very important period for me as I had to finish up all the Kaplan notes, BRS for physiology, High yield neuroanatomy, Goljan for pathology along with videos of Dr. Najeeb.

I had also started reading first aid some time around the early part of May.

Dr Najeeb’s videos were extremely useful for some chapters of physiology like Respiratory (highly recommend), Renal, Cardiovascular (ECG) and any other system which you are particularly weak at. Again, this is very time consuming because you need to take down notes for the same, BUT they are totally worth it.

Lectures for reproductive and endocrine physiology and GI physiology are a waste of time and I do NOT recommend doing them. You can refer to the Kaplan videos for the high yield systems for physiology if time permits.

With reference to Dr Najeeb’s videos, neuroanatomy requires a special mention. His lectures on intracranial hemorrhages, spinal cord lesions, meninges and the vestibular system are the only ones I could do due to a time constraint.

But his neurology lectures are pretty elaborate and I would recommend doing most of them only if you have started your preparations in advance and can spare time for these. Now you can do away with these lectures as the neuroanatomy questions that show up on the main exam are relatively simple. But that is my perspective and opinions may vary.

This was also the time when I finished reading Goljan for pathology. Again, a time consuming process but a one-time thorough reading is definitely recommended.

The Kaplan Q bank was particularly useful during this period as it helped me apply what I was reading and also helped me with time management. I never faced a time crunch for any test- Neither U world nor NBMEs and Neither on the main exam.


I started solving my U world Q bank (3 month subscription) in mid-June.

Now this is a MUST-DO for the exam. There is no escaping this and each and every question needs to be solved and reviewed at least once.

I solved the tests on the Timed mode. Initially, I would combine 2 systems together and solve tests till I had about 80-100 questions pending per system. Now this number is variable as some systems have a lot of questions but others have very few.

So be judicious and careful. The last 30 tests or so that I solved were mixed, like they show up on Step1.

Reviewing the tests is a task and it took me practically 4.5-5.5 hours to review each test. I would practically write down every little detail form u world into my FA. I had to attach at least 5-6 extra sheets per chapter to fit in the notes after there was no more space left on the FA pages.

But doing this helped me a lot as my first time doing U World was very thorough and I could read up my notes every time I revised first aid.

FA is the only book recommended while you’re in the whole U World phase because you need to get thorough with FA and you practically do NOT have the time to read anything else, especially if you’re still a student. You cannot compromise your academics at any cost because they matter equally.


26th July onwards till the date of my main step (1st September).

This is the time to solve NBMEs, Kaplan simulated exams, Uworld self-assessments and also continue revising FA.

I did the whole of FA thrice. A minimum of 2 readings is essential. You can revise the U world tests if you want to during the last 1.5 months.

This is a timeline of my tests and the scores on each (All taken in the year 2015)

Kaplan simulated taken on 26-7-15 score 81%
NBME 15- (2nd August) 251
NBME 16- (15th August) 260
NBME 17 – (25th August) 254
UWSA 1 – (8th August) 263
UWSA 2 – (23rd August) 262
UWorld Total – 77%
UW LAST 30 TESTS – 82%
Kaplan Q Bank Solved 54%. SCORE 72%
Now a lot of people wonder what a good score is and many a times get de-motivated with their NBME or UWSA scores.

The deal here is NOT the individual scores but your progress and consistency.
If you are scoring in the lower range (220-230) in your first NBME, your scores are bound to increase in the subsequent ones. So try and maintain a graph that is positive and if you have reached a point of saturation (250+) try and maintain that.

The length of the questions on the main step corresponds to the length of the UWSA questions, but the difficulty is more along the lines of the NBMEs.
The key here is to NOT get bothered, even if your scores are below your expectations. You have to work hard, keep going and give it your best shot on the main exam.

Go through the heart sounds over and over again and also the CTs, MRIs and other images.

There is a discrepancy between my test scores and my actual score. This is because, while doing these practice tests, I realized that I had a crazy tendency to over analyze the questions and keep changing my answers and that actually got me a lot of incorrect questions.

So I restrained myself from last minute changes and went with my gut feeling. It was a risky move but it paid off for me. So try and analyze why you are going wrong and work towards correcting them your way.

USMLE Step 1 Experience – The D-DAY

Ohkay! Now I could fill up an entire page again on my experience on the day of the exam. But I’m going to keep this very concise and give you bullet points of the DO’s and DON’T’S


  1. Get a good night’s sleep one day prior. Have a well-adjusted circadian rhythm. A sleepless night and anxiety won’t get you anything.

  2. Wind up all your last minute revisions by the evening of the previous day. You have to resist the urge to keep going through FA. It messes with your mind and confuses you even more.

  3. Comfortable clothing is the way to go. Preferably no pockets.

  4. FOOOOD! Please carry good food and enough drinks to keep you hydrated. Anything that makes you feel good. Chocolates, cookies… Whatever. It makes a difference.

  5. Plan your breaks appropriately. Take a break after every block if you need it. I did the same.

  6. Don’t panic staring at the questions. Try and guess an answer even if you’re not sure. Try NOT to skip and leave too many questions unanswered till the end because that can stress you out.

  7. Pee when needed.

  8. Never re-enter the exam room from a break just for the heck of getting done with the test. Re-enter only when you feel fresh enough for another block.

  9. ENJOY after the exam regardless of how it went. You deserve it.

  10. No USMLE predictor (online) can predict your actual score.



Have some faith in all the efforts you have put in for this one day. It will pay off in the end. Don’t let your worry get the better of you.

(And then finally wait for 3-4 painful weeks for the results to arrive)

THE REAL DEAL: 267. (23rd September’15)

It’s a long journey and it tries your patience at practically every other level. From an ECFMG certification to the application and what not.

But that’s what you have friends for. Having a study partner helps you get through this exhausting process alive and breathing.

It’s tougher when you’re all by yourself with no one to handle those frequent panic attacks and nightmares. Yes we all go through them and it can mess with you.

And the only silver lining at that time is the support of your family and friends who believe in you more than you believe in yourself.

So don’t lose hope! And HAPPY STEP 1 DIARIES to all!!

Dr. Priyanka Lakshmanan has scored 260 on the USMLE Step 2 CK (read her Step 2 CK experience) is now doing clinical rotations in the US. She plans to apply this year for interviews. We wish her all the best