Step 1 exam preparation experience
Though it’s not an inspirational score for which ideally this experience is followed, but i was askd by
few colleagues to share , i hope it may help u somehow.
=> Duration 15 to 18 months actually
=> Target 250 above/ real deal 245
=> sources :
Kaplan notes with videos except patho
First Aid ( most influential source)
pathoma ( best easy patho source)
Goljan ( best patho book but it’s giant)
Uworld ( 2nd very important source after F.A)
Brs physio ( better than kaplan )
uw biostatitcs review
kaplan Q bank ( genetic, biostatcs , moleculr biology, pathopgysio) optional
100 cases of ethics
anatomy shelf notes ( optional )
medscape , google, snell ana review for major muscles of body compartments and pelvis, other
ana main information like contents of poplital fossa, femoral triengle , sciatic formanina
contents etc (optional)
Alright ,i am graduate of chandka medical college (Pakistan) . After graduation , i did my housejob
(internship) , after that i gave local pakistan postgraduation exam FCPS… after passing i felt secure to
enter in USMLE world exam and gave it in april of this year 2017 and got my score after huge worth
killing gape of 2 months on this 28th june 2017 due to some exam questions modifications done
before couple of days of my exam date, which caused prolonged awaited for result …
Initial phase :- kaplan books phase ( 6 months )
i started with kaplan books along with video lectures , it took too much time round about 4 months, so
finally done with it , then i thought to revise it with some strategic move to retain and revise effectively
important knowldge and throw out extra unwanted information when need comes . For that i started
making precise summery or notes in a nutshell of every page of kaplan in blank space provided on side
of every kaplan book page ( quarter size blank space on every kaplan page ) , so it took lot of time
again, i realized i had done it in first run so that i would have saved my time in revision of it . During
that time i felt kaplan physio somewhat not to the point and followed brs mainly which i found
satisfying choice . i read pathoma with videos ( very good concepts ) instead of kaplan patho and made
short precise notes for it too on blank space provided there for no difficulty in revision. i read goljan too
because i had used it during undergraduation so here intermittently i used it too .
how i made those summeries or notes , let me give simple examples
suppose i read sickle cell anemia from pathoma , now after reading i would write it in side on blank
space parallel to same topic
= A.R = glutamate is repalced by valine in beta globin chain = both gene defect then hbs>90 perc
hb polymerise when deoxygenated conditions( acidosis , hypoxemia , dehydration ), these conditions
repitatve then sickling , sickling desickling going on when rbcs go to microcirculation ultimatly irrevesible
damge to membrane and extra and intra vascular hemolysis = massive erythroid hyperplasia in skull ,
face =extramedulry hematopoesis in liver =autosplenctomy , vasooculsive crisis ( dactlitis in children
infants , acute chest syndrome precipitated by pnemonia ->MC cause of death in adults , renal papilary
necrosis =hydroxyuria given to increase HBF Fetal etc
2nd eg => regulation of bp
1 . barorecptr reflex = mint to mint= carotid sinus in ICA = dec bp -> dec stetch -> dec affernt influx to
solitry nuclus-> incre SNS and dec PSN
from vasomotr center in medula increase sns cause 4 things a. inc hr b. increase contractly , c.increase
tpr, d.increase venoconstriction so blood more go to heart and output.
2. long term - RAS AG11 . angiotenin 2 ( AG11) do 4 things a. increase aldo ,b. increase tpr ,c. inc na/h
pump in pct , d.increse thirst
3 cerebral ishcmia =–increase pco2 in vasomtr -->chemorcptors—> increse sns dec psn – >inc bp it
again causes compression of brain vessles --> ischmia --> incre sns dec psn more --> increase bp
drameticaly (cushing reaction)
4, chemorecptors in aorta (aortc bodies ) , carotid (carotid bodies) ==dec po2 increase–> snc dec psn
5. adh in hemorage 6. increase pressue --> natiruesis, diuresis by anp also dec renin …
if u stil have confusion , i can provide summery notes of any topic u want to make sense just for demo
purpose so that u may have idea , how to make summery in own way . Although most of things wrtten in
fa densly , but kaplan gives bettr background concepts.
2nd phase :- uworld ( 4 months)
so in this phase i started uw subjectwise like pharma , patho , biochem , genetics, etc Eg . i would do
pharma cvs from kaplan nutshell hand made notes ( on blank spaces on every kaplan page mentioned
above ) ,then after completing it in few hours , would do same from uworld with highlighting main
main stuff . So this went on with three to 4 months slowly with lot of distractions . Doing kaplan helped
alot in reading uw explainations bcuz major portion of uworld explainations were simulating kaplan
notes.
3rd phase :- uwolrd for annotating major stuff on sperate note book 2 to 3 months)
this time i felt uworld a very huge source , so i wanted to make those highlighted information on separate
note book according to my approach and consideration for easiness in revision . Dont understimate uw by
thinking these 2500 questions just , trust me it will make u numb in end if u get it as granted.it’s very
tragic to annonate things from one source to an other place , but in end it is fruitful. note : make ur own
notes in ur language and according to ur approach , don’t follow others.
4th phase :- first aid and intergrating all other sources phase (2 months)
this was most crucial phase , i did F.A simply then tried to integrate concepts of uw , kaplan hand made
notes , brs physio , pathoma and first aid … i was too much baffled due to having already lot of major
precise hand made concepts of kaplan on those kaplan books pages ,brs physio, pathoma , goljan which
were missing sufficienltly for me in fa such as physio of cvs , resp , kideny etc , neuro ana concepts , gross
ana proper sequance , genetics , biochem concepts, molecular biology , immunology concepts ,
biostatitcs etc so here i perplexed and wanted to make strategy to solve this dilemma , so made mind
to annotate those all main stuff but this time on fa self , it was very disorderd time for me , so finaly did
that and made one book only the ultimate book (F.A) so that in end i don’t run here and there …
5th phase … extra material ( couple of days )
here i got familiar with ecg (ecg made ridiculously easy) , murmers , ct scan , mri , xrays , major muscles
their pics for location from google , pics of brain gross to be much familiar with its parts likike BG parts
location, fissures , lobes , mammilry bodies , pinal gland , hypothalamus , pituitry location, cranial nerves ,
brain slides , uw main pics , cvs and resp clinical examinations etc
6th phase . revision phase ( remaining duration )
i revised thoroughly all sources from one book that is Fa , and gripped Fa …here i also revised uw from
notes .i revised fa few times until i got very friendly to it , also read biostacts uw review , 100 cases etc
Final phase :-
i had already taken date of exam during revision phase as i was fatigued and i was confident enough to
get good assessment scores so here i started solving NBMES , UWSA etc
i just did uswa1 , 2 and online 17 one and half months before exam date to assess and got satisfactory
score so moved on solving other new nbmes 18, 19, 15 , 16 ,13 i had no time to do remaining nbmes
so left those , but i wil advise u to solve as much as u can .
here i made schedule of 20 days before exam to revise all things according to my approach and comfort
level ( fa , uw , 100 cases , biostatcs review , all other extra sources)
one day before exam :-
Friends i’ll advice to u to chill , go out with your fav people , make party scene and full time relax . it is
necessary to do nothing one day before exam , but here i was in position to not stop myself revising , and
it went on whole day from morning to mid night , at this time i thought to stop bcuz i had to wake up at 6
am , but i was unable to sleep, so took short acting sedative after few hours , which gave me 2 hours
sleep form 4 to 6 .
Exam day :-
first time in prometric center , fearful and having guilt of not enough sleep that really affected
performance with heaviness in mind , nausea , slowness . so i will advice u to not study one day before
exam and sleep for enough time .
1st block was somewhat difficult with lot of biostatcts calculations, some weird paedz and obstetrics type
questions which were more like ck type , 2nd block was also of same difficulty level with lot of behavrl
science , clinical based questions and molecular biology Qs with big scnerios of mutations , no time
remaining for review but u can do if u have good concepts , 3rd to 4th block somewhat less difficult
testing pharma , microbiology ,immunology , again 5th block difficult with pathophysio Qs and
general principals with some tricky graphs , remaing two block were easily doable . Total 7
blockks with 280 qs … majority of Qs were with pics given be it ct scans , mri , histopatho or graphs and
few multimedia type like chest auscultations , murmers , ecgs etc
overall 70 percent Qs were doable from above mentioned sources , 20 percent again doable but
somewhat complicated and with distractors and with matching 2 to 3 options. 10 percnt were
WTH type with experimental weird Qs but u have to proceed thro just educational guess.
my self assessments scores
USWA1 258 one and half month before exam
USWA2 263 one and half month before exam
NBME 17 255 one and half month before exam
all three above on consecutive days
NBME 18 offline 250
13,16, 15 , 19 for learning
Mistakes :
=> started fa lately , i would have used it earlier systemically with first read of kaplan .
=> wasted too much time on kaplan and fa annotations , i would have annotated from kaplan , brs
physio , pathoma main main conecpts to fa in first run … i would have made notes of uw in first run
to save time .
=> took too much time overall … more time we take , more we become confused overall
=> did solve only few nbmes .
=> studied on last day so became overwhelmed . Trust me , it will ruin ur performance
advice:
=> its for my pakistani colleagues , dont do FCPS part 1 before step 1 if u r very determined for steps , u
can clear it easily after step 1 exam without preparing much.
=> according to me , there are 3 ways to proceed
- kaplan books with vedios , fa , uw and other books like pathoma , brs physio , 100 cases , uw biostatct
review etc etc - selected kaplan topics according to ur need of concepts and deficits in fa , fa , uw , 100 cases ,
pathoma , brs , biostc uw reviw - no kaplan but just fa , uw and other books like pathoma , brs physio , 100 cases , uw biostatct
review etc
its ur choice how u go according to ur basic background knowldge , satisfaction , time , other conditions.
if u use kaplan , i will suggest u to proceed thro any one way from following 2 possible ways - make very precise notes of that whole page on blank space given at every page in first read in
that way , so that next time means second time if u go thro kaplan then u only read those short notes
very fast ,say in 1/4th time u studied in first read , then start fa and see where it looks u difficult and
deficient and annotate those already self made notes here now in fa . - start kaplan and other books systemically with fa, say if u want to start cvs , do its physio first from
brs then read fa same , and see whats difficient where is it , so directly annotate that major concept or
stuf on f.a so it can save ur time even more . lilkewise in patho, pharma sections of cvs , do it first from
pathoma and pharma from kaplan then go thro fa and see where is it deficient accrding to u , then
annotate here in f.a …
For me , atleast these kaplan topics are necessary to do for good concepts and memorization
pharma :- pharmacokinetics , pharmacodynamics, autonomic nervous system ,cvs( many concepts are
deficient in fa take one simple example mechanism of smooth muscle contraction and relaxation and
drugs affecting them figure on red (2014 ) kaplan page 105 , cns , antihistamines , drugs acting on
serotonergic systme ( good memorization about serotonin recptr drugs ), eicosanoid pharmacology
,steroid hormones , toxicology … all these r wrttn in fa but u need some good integrative concepts which
u need in real life and exam . Not only memorization helps in exam as in fa
ana :- gross ana whole( specially upper and lower limb nrevers classifcations , blood supply,
dermatomoes supply and nerve defects deficits, blood supply of abdoemn classification , hernia,
autonomic ns whole structure , pelvis must , all cts given in end of chapters , and nueroana must
biochem :- moelcular biology chapters except last chapter , whole bio u will be having good concept
about cycles , diseseases , genetics is high yield especially concepts missing in fa like gene mapping ,
genetic diagnosis and pedigrees given in last , recombination pedigrees , many QS were tested on exam
behavrioul sciene : health care delivery system , substance abuse , biostatcts and epidiomolgy with
lectures must
immunology whole nice concept there
but i must say , fa is very dense book containg information without background concepts , so go ahead
according to ur background knowlge , kaplan is not worthless , it makes ur concepts better , though those
are written in fa , but concepts u wil make mostly from kaplan , again it is according to ur approach .
=> make 2 books …One book that is F.A with all major annotations from notes of kaplan , brs ,
goljan , other major stuffs on this but not uw . if there is problm of blank space then attach sticky
pages pages … note : only use major concepts or things which u get as deficient and important … only
write deficient concepts ,otherwise u wil get overwhelmd during revision and u wil get exhausted and
distracted in end . 2nd book is ur uw notes.
=> no need to do all kaplans … u can leave micro ko kaplan , patho kaplan, physio kaplan , histo kaplan
confidently.
=> uworld is equivalent to f.a source in importance , u must make small comprehensive notes in first run
on seprtae note book .
=> brs is best book of physio , do that fully
=> pathoma vedios and notes
=> 100 cases of ethics mandatory
=> biostatc uw reviw again necessary stuff
=> no need to go behind high yeild series .
=> do Goljan in following topics if u r really willing to be competitave and have enough time, i have
annotated main things from these topics on fa.
( inflammation , amyloidosis types , hypertonic isoto nic hypotonic disorsders(NB) ,pottasium
disorders , ABGS ( metablic , respirtry acid base and mixed, concept NB), thrmbosis types , embolism types
, congental anomalies types , age related and age dependant diseases,environmrental pathology(NB) ,
protein energy malnutrition ,inherited cancer syndromes , paranoplastc syndromes, paraneoplastc
endocrinopathies(NB), lipoprotien disorders, vascular tumors , myocardits , pericarditis , tumors , types of
heart failures (systolic diastlic ) , hb electrophoressis findings , microcytc anemia findings in lab , summary
of normocytic anemia types, finding in cbc in lukemis , lymphoma , polycythemia , esnophls , neutrophil ,
lympho , baso disorders and their shape of cells , plasma cell diorders , langerhans cel histocytosis , types
of non hodgkin , hodkin lymphoma , coagulatiom tests normal values , platelete disordrs classification, Cf
, small interstinal obstruction causes table , diarhea types , ibd table , tumors of gi of children and
adults(NB) ,causes of jaundice , lab findings of diffrnt types of jaundice(NB), autoimmune hep , types
of protienuria table , urnialysis(NB) ,prostatitis , testiculr tumors classification ,dysfunctional uterine
bleeding , amenorhia types , ovarian tumors classification, moles , causes of hypercalcemia ,
hypocalcemia ,summary of calcium ,phosphorus, parathroid hormone disorders lab tests(NB), islet cel
tumors , types of strokes , selected eye ent disordrs table .
= > i was told by few people after my exam , i dont know its reliablity of following fact.
don’t take exam when there is mentioned about delay of 2 month in result . let me make it clear , there
was mentioned on ecfmg web that whoever wil take exam after 24th april of 2017 , wil get reult on 28th
june contrary to usual 3 weeks duration of gape for result . it is due to fact that many QS in pool are
modified every year or 2 i dont remebr exactly , so this time Qs were modified on 24th april so as i
took exam on 27th april , my result was compared to all candidates who appeared till 28th june means 8
weeks , so no of candidates increased and as u know exam is abt percentile , how many candiates do it
right or wrong is calculated in that way so more candiates, more chances they make those Qs right ,
less score comparetively u can get probably in comparison to people who gave exam in may or june near
to result .
=> self assessment gives u idea where u r , yes it predicts abt ur actual rersult , but actual exam day
performance matters alot , how u manage that according to time managment and stress. i have seen
intelligent and hard working people got low scores and average people who gave in hurry got more than
expected , so dont compare ur score and dont judge people on its basis . hardworking plus luck matters
too , so do it sincerely and its outcome leave to God …
i think i wrote alot according to my insight , hope it may help u . Work hard , don’t think abt its
outcome , if others can ace , u can also , so believe in urselves and there is always chance of
improvement , early or late u will ace it one day … best of luck , remember in ur prayers
by : Sunny Ramrakhiani
