STEP 1 IMG EXPERIENCE
I organized this in the following sections so you can skip to whatever you are interested in:
Goal, Resources, Thought Process, Prep, The Good, The Bad, The Ugly, What would I do differently, and final thoughts and recommendations.
I tried to be as concise as possible but there is a lot to cover, so pardon the long-ass post hah.
GOAL: > 260
SCORE: 262
RESOURCES:
-Books: First Aid (Once)
-Videos: Boards and Beyond, Physeo (Just Biochem section), Pathoma
-Audio: Goljan YouTube series
-Flashcards: Made my own in Anki
-Question Banks: UWORLD with a second review of marked ones, AMBOSS, USMLE Rx, Kaplan, Pastest (Half of it), Medbullets (Half of it)
-Assessments: Did all of the NBME (1-24), UWSA1-2, Pastest SA1-2, Kaplan SA1-2, AMBOSS SA
**I used NBME 1-17, 21, 23, 24 as well as those from Kaplan and Pastest just as learning tools, not to predict my score, although I did keep track of the % of wrong answers and tried to improve on it.
**To predict my score I did (in the following order):
-AMBOSS SA 246
-NBME 19 257
-UWSA1 269
-NBME 22 249
-NBME 20 251
-NBME 18 263
-UWSA2 267
THOUGHT PROCESS:
In brief, my thought process went like this: This is a 280 question exam that relies heavily on very detailed factual information that is often asked in a convoluted (for lack of a better word) manner. Therefore, I need to optimize my conceptual recall skills and get as much training as I can in using that information to answer difficult questions.
PREP:
I started prepping for Step 1 during my internship year in Colombia. Although time was constrained, I managed to watch almost all of Boards and Beyond videos, listen to Goljan series, read First Aid and took notes of everything on google docs. I then dedicated 6 months entirely to answer question banks. I usually had 2-3 qBanks running simultaneously during any given month, initially did on average 150-200 questions daily, but as I´ll address later ended up doing just 40 to 80 questions per day.
My planned schedule looked something like this:
-Woke up at 6 am and did 1-2 blocks of 40 UWORLD questions, usually finished around 12-12:30
-Hit the gym from 12-2 and had lunch for about an hour
-From 3-7 pm did 80-120 questions of a second qBank
-7-8 pm Flashcards
-8-10 pm spare time
I managed to keep up with this schedule for about 3 months, and during those, I saw rapid improvements in my assessments (passed from around 50 incorrect questions in the old NBMEs to 15-25 in the semi-old NBMEs) and also in the average correct % in my question banks (Started at the mid-60s and went all the way up to mid-80s).
The problem was, that although effective, it was very demanding. The fatigue accumulated quite rapidly and I started to struggle to keep up with my daily goals. In the end, I was forced to change my strategy during the last couple of months because I literally couldn´t handle it anymore (More on that in THE BAD).
THE GOOD:
The best decision I had regarding my prep was to prioritize question banks above everything else.
The thing about solving questions is that they don’t merely teach concepts (Just as any other book or video); they teach DEPTH of concepts. For instance, during my prep, I learned that alcohol inhibits the normal function of vasopressin, and that´s why diuresis is increased after drinking, however, it wasn’t until I came across a question that asked me the expected levels of ADH on a patient who recently consumed alcohol, that I realized I wasn´t sure if alcohol exerts its effect by blocking the vasopressin molecule or receptor (And thus increasing ADH levels), or its secretion (Thus decreasing its levels). There is no way in which I would´ve realized that gap in my knowledge if it hadn´t been for that question… And trust me, you´ll be in the same position if you start doing questions more frequently.
And that is exactly what you should aim for. To bear under scrutiny every bit of knowledge you think you have so that you get some insight into how ignorant you truly are. It is the only way to know exactly what level of detail is needed to reach your goals.
Putting that aside, doing questions helps to enhance your memory, and according to current literature, it is a far better method than reading your First Aid notes for the third time in a row. It´s more fun as well.
THE BAD:
I underestimated how demanding the prep was going to be. I consider myself a disciplined person and given that I already had gone through an internship (Supposedly some of the hardest months in the career) I thought that the Step 1 prep was going to be easy.
Big mistake. Mental fatigue is just as bad, if not worse, than physical fatigue. As each day went by, I struggled to keep up with my set goals and eventually ended up flagging behind. In an effort to overcome this, I started using the free spaces in my schedule to catch up… Worse mistake.
THE UGLY:
3 months into my prep and I felt tired all the time, even though I was eating right, sleeping 8 hours daily, and exercising regularly I felt slow and unmotivated. I started to fall asleep in front of the computer, answer questions incorrectly due to lack of attention, and overall I just wanted to quit.
If you´re not careful, you may end up in a similar place. Where your efforts to make the most efficient way of prepping turn you into the most inefficient prepper (Ironically enough).
WHAT WOULD I DO DIFFERENTLY
1 Take it easier.
During the last months of my prep, I decided to take a step back and rebuild my schedule from 0. The first thing was accepting the fact that my current situation was a mess, and doing 200 daily questions just for the sake of doing them was clearly not the way forward. Although my scores weren´t bad by any measure, I realized that I kept getting the same kind of questions wrong. I recognized that I was so caught up in finishing the daily objective that I hadn´t given myself the time to stop and learn thoroughly some of the content.
So I did just that, I sacrificed finishing the Pastest and med bullets question banks to have more time to properly learn some of the content which I struggled with. The sweet spot for me was 40-80 questions daily. This allowed me to stop if I needed to, and learn the dammed content so that the next time I grappled with a similar question I could figure my way through it.
I also cut back on daily study time. From 10 hours to 7-8. Reinstituted the things that I enjoyed in life besides studying, like watching movies, learning new things, going out with my friends, taking naps, etc… I regained balance, and with that, motivation, willingness, and confidence to finish my prep.
If you´re in a similar situation right now, take a step back, reconsider your reasons for doing this, and remember that although efficiency is imperative to materialize your goals, consistency is the means by which efficiency unfolds itself.
2 Sacrificing quality over quantity…
In my attempt to be the best, I tried to cram down every resource I could, I thought “The more, the merrier”. And to a point, that argument makes sense. However, if you find yourself constantly postponing the review of difficult/lengthy subjects just to finish your set goal of the day, you are putting the cart before the horse.
In a nutshell, my advice would be: Do as many questions as you can, for as long as you can, while taking the necessary time to REALLY comprehend what they are trying to teach you, and not just memorize them.
3 Needlessly wasting time with First Aid, note-taking, and easy flashcards.
I reckon this is an unpopular opinion. But I truly believe most people place too much emphasis on First Aid and note-taking.
The problem, as far as I can tell, relies on 2 main points:
- You´re wasting a huge amount of time creating a system that has shown to be inferior to active recall: On average, taking notes by hand is 2-4 times more time consuming than just reading. The reason why we accept that inefficient use of our time is because we hope to create a commonplace that helps us remember information better… Except that it doesn´t, especially in the way that most of us take notes, which is by translating the text from one place to the other. On top of that, you then choose to spend more time reviewing those notes than doing something else, (Like more questions)… This creates a loophole of passive learning that has shown to be inferior to active recall techniques.
- You don´t have an infinite amount of time, therefore, the time you spend in re-reading and taking notes is time you ARE NOT spending in solving questions and other forms of active recall… If you stress such a huge amount of importance on focusing on “High yield resources”, why would you spend let´s say half of your time on “Low yield techniques”? Makes no sense to me…
Some people may argue that great scores are seen in people who read 4-6 times First Aid. But let´s not forget that people are often successful not by their actions, but in spite of them. Furthermore, as UWORLD has taught us in the biostats questions: There are always outliers, who perform well/bad despite whatever they choose to do. This should not be confused with the general tendency, which is that solving questions improves your performance, and re-reading not as much. I´ll leave a couple of titles on some of the USMLE specific research that supports my claims if you want to dig a little deeper:
-Burk J. Study behaviors and USMLE Step 1 performance: Implications of a student self-directed parallel curriculum. 2017.
-Johnson J. Are questions the answer? The effect of popular study resources on USMLE Step 1 performance. 2011.
If I could go back, I would´ve focused on doing questions during my internship along with the BnB videos instead of reading and taking notes from First Aid.
On a side note, I used the AMBOSS library to search for the topics which I struggled with, and I highly recommend it. It´s thorough, covers everything First Aid does, easier to search, remains high yield, excellent graphics. If you are looking for somewhere to read, try it out.
Oh and, about the Flashcards… They are great, my problem was that I created too many, often with concepts that I could easily remember by other means. I ended up with 14.000 flashcards are there is no way to review all of them while trying to do a bunch of questions daily. My advice with them is definitively to use them, create them yourself on Anki (Don´t recommend premade decks), and be very very selective on what you put on them, your time is valuable, so don´t waste it on easy/low yield facts.
FINAL THOUGHTS AND RECOMMENDATIONS
- As stated earlier always prioritize consistency over efficiency; quality over quantity; understanding over memorizing and questions over re-reading and highlighting
- Learn to enjoy and love the process. It is an acquired skill though, you need to both make a routine that you like and constantly remember the reason behind all of your effort. If it is not enjoyable ask yourself, how can I make it so?
- Be careful with the flashcards, they are a great tool to remember details that you easily forget, but if you´re spending large amounts of your time on cards that pose no real challenge (Like most premade Anki decks do), you are just wasting your time, limit the cards to the subjects that you struggle and forget repetitively.
- Do assessments, as many as you can. Not to just predict your score, but to learn, after all, they are questions, and they may teach you the fact that makes the difference between a 259 and a 262 in the real deal (I found some interesting concepts on the NBMEs that weren´t in any other resource, even in First Aid)
NBME 1-7 and Kaplan Self Assessments are the least useful ones. The real exam looks like a mix of NBME 18 and UWSA2. My score was best predicted by NBME 18… And forget the idea of “bias” in your exams and assessments. You WANT to be biased, in fact, your whole objective should be to be as biased as you can be, to have seen all of the questions that may come up at least 3-4 times before the real deal. The whole point is to feel as familiar as you can with the content. Why would you want it any other way?
Finally, I would like to thank this group. The experiences posted here guided my journey and gave me something to strive towards. I hope my experience helps others in the same way.
Por ultimo, para mis colegas que hablan español subí este video a YouTube donde explico mas a profundidad mi experiencia con el Step 1, planeo subir mas contenido relacionado en el futuro por si se quieren suscribir!