USMLE step 1 exam experience

USMLE step 1 exam experience:

By: Hamza Mousa Alzghoul, a 6th year Med student at Hashemite university, Jordan.

Took my exam may-31st-2020.

Score: 271 (I guess it’s at the 100th percentile rank)

Target: 250+,


UWORLD 1st pass (online) : percentage of correct questions: 90%(2562 questions), percentage of incorrect ones: 10%(298), only 3 questions omitted. Percentile Rank:97th. The score report that Uworld makes at the end of your subscription is the most important, reliable and helpful estimation of your performance. The highest percentile rank was in Biochemistry and genetics (99th percentile, only 5 incorrect questions out of 235) and the lowest was in social sciences (Ethics/ legal / professional): 18th percentile!!! I’ll explain how I dramatically improved myself in this topic in the preparation section.

UWSA1 (online): I did it in June the 20th/2019. Score: 275(14 questions wrong)

NBME 24(online): 264, 6 months before the exam.

NBME 15(free, online): 11 mistakes, 259 (super hard curve), NBME13: same. Done a couple of weeks before the real deal.

UWSA2 (online): did it after a very long pause out of studying for some bad circumstances to know what I need to review (262, 18 mistakes) most of them were silly mistakes. Made me knew that I had to review first aid again before stepping into my exam.

Free 120 (online): 2 days before my exam, 96%, 5 mistakes only. The best assessment tool ever made for step1. It’s the closest one to the real exam.

I did most of the remaining NBMEs as learning tools (offline) some of them were very easy (NBME 17, 19) others were superhard (NBME 20, this is the toughest assessment form that represents the worst scenario you may have in the real deal). The remaining NBMEs were just average.

Duration of preparation: I would say 2 years, with so many ons and offs, I was ready for the exam for a very long time before taking it, had some bad circumstances but through it all I did it at the end.

Note: I just study to gain knowledge, I don’t care that much about scores… that’s why I studied many unnecessary resources for step 1. Don’t be overwhelmed by them. I’ll highlight what you need to study to get a high score.


First aid for the USMLE step 1, approximately 5 full revisions.

UWORLD question bank (online): I did it only once, but it took me a very long time because I annotated everything new on my FA. You definitely don’t need to do it twice… just do it once online, take your notes, make your flashcards. And try to do it in the timed mode. I did all its questions timed systematic (not random)

mode. Marked around 250 questions and did them again in the random timed mode.

Review books

For biochemistry: Kaplan with 2010 kaplan videos. They’re better than 2014 turco videos (tried them both) and I gave kaplan book a 2nd pass. It’s the best review book to study biochemistry.

Pharmacology: Kaplan with 2010 videos. I also did endocrine pharmacology from Lippincott’s (didn’t make a big difference).

Physiology: I love it, I really enjoy reading physiology and pathophysiology. I used the big Costanzo book for it and it was incredible, did it twice, cover to cover. And reviewed the topic from BRS physiology review book (by Linda Costanzo)

No videos used.

Pathology: Pathoma (with its videos) a very good review book, but it’s just a review, contains some mistakes scattered here and there, not very good in pathophysiology (oversimplified) and management. I used it hand in hand with UpToDate and added Goljan (I love this book, but trust me, you don’t need it for USMLE step 1, what is in Pathoma is more than enough, so understand it well.)

Anatomy: I hate it, but I studied it will, it’s just a matter of pictures… studying anatomy without good pictures is like not studying it at all, I think I passed through every single page of Netter’s Atlas of anatomy, this is definitely not necessary for step 1, but I can’t do anything satisfactorily without knowing the details of the details. I also did Kaplan with 2010 videos (except neuroanatomy section), it was very good and more than enough for the exam. I also did High yield gross anatomy (not necessary).

Regarding neuroanatomy, it’s my field of interest, I love neurology and enjoy the complexity of it. During my basic years I studied an incredible textbook for neuroanatomy and it helped me so much in step 1 preparation. Snell’s Clinical neuroanatomy (around 560 pages I guess, I did it cover to cover but I advise against doing it for Step1 preparation, it takes time. However if you’re still in your

basic years you should do this book. And you’ll love neuroanatomy. I did it with Dr Najeeb videos back then.) For step 1… Just do boards and beyond videos with FA for neuroanatomy and you’ll be good. Some people talk about HY neuroanatomy, I think it’s a piece of shit.

Embryology: High yield embryology, Good one, can be done within 2 days(time effective), it’ll make you feel comfortable with the subject. Kaplan anatomy videos explain embryology very well. I think a little bit of embryology can go a very long way, for example you won’t understand gastroenterology without understanding its underlying embryology. So make sure to enjoy it.

Behavioral sciences and Biostatistics:

The biggest problem for IMGs, and it was the biggest problem for me.

Behavioral sciences include ethics n legal sciences and psychiatry… ethics can be tricky, but psychiatry is the easiest section in USMLE step 1, for which I did Kaplan with its videos and BRS behavioral sciences…. But for psychiatry you need nothing other than first aid. You can use boards and beyond videos to ease the process of going through it.

For ethics I was initially very weak at it, but I strengthened myself by doing BRS, Kaplan, and 100 cases by Conrad Fischer( the best resource for ethics, just do it n you’ll master it) and solved so many ethics questions from many test banks. Medical ethics literally became my little game after it was my point weakness.

Question banks:

  1. UWORLD, best resource for step 1

  2. USMLE Rx Offline: I did the whole Qbank with a 96% correct questions. The old offline one is easier than uworld, but the online bank is tough, they updated it. I made a 5 days free trial and solved some of it….it’s very good… do it online.

  3. First aid Q&A for the USMLE step 1 book: 95% correct. You don’t need it.

  4. Amboss: this application is very good, probably the best resource currently available for USMLE, but it wasn’t popular when I started my preparation so

I didn’t use it well. It could’ve saved so much time… I only did around 500 questions online. They were really good.

  1. Kaplan qbank: I did only around 100 questions in an online free trial. Good one if you have enough time.



I used it very often for so many subjects and to find answers for whatever question I don’t have the answer for… you’ve to use it wisely, I just use it to look for something specific, so I go to a certain section of an article, I read it and I close it… as simple as that… for example if I need to know about the pathogenesis of fibromyalgia which is said to be idiopathic… I just search it on the UpToDaTe’s server and I read the pathogenesis section ignoring others such as epidemiology of the disease… I just didn’t come here to know epidemiology so why bother.

Wikipedia: In a word….incredible….this website is really amazing, how comes an unspecialized website to have that much details in every single thing you search about! Only Wikipedia network has the answer!

Exam day:

Last week before my exam I had a severe insomnia…in the last 72 hours before my exam I only slept for 5 hours total…only 1 and a half hour of them were the day before the exam. But any way I decided to take it after countless rescheduling permits due to the pandemic and center closure in addition to other previous circumstances… I prayed to god that the hard work pays off. Drove to the exam. And it paid off. Thanks god.

The first block was a piece of cake…. I was certain that I didn’t make any mistake in it. After which I took a small break…then did 2 blocks…they were hard…so many questions are really tricky,

that kind of questions that you think and get confident you got right, but the sad fact is it’s not as easy as you may think…. Many questions in my exam were like this…if you didn’t solve so many questions you won’t be able to spot that kind of tricky badass Qs.

In my 5th block I got really tired!! I’ve never felt like I wanted to sleep like this in my entire life before….For a moment I thought let’s get the fuck out of here and sleep for an entire week 😛

But I just took a 30 minutes break after it… ate some snacks and drank a starbucks frappaccino that a friend of mine brought ❤ and did the remaining 2 blocks with a wakeful mind 😛

Each block I marked 2-4 questions. Except the first one, I marked nothing… and whenever I had the time I reviewed as much questions as I could.

At the end I would like to quote from my favorite song (MY WAY-FRANK SINATRA):

“Regrets? I’ve had a few, but then again… too few to mention

I did what I had to do,

And saw it through, without exemption.

I planned each charted course, each careful step

Along the by-way

And more, much more than this

I did it, my way.

Yes there were times, I’m sure you knew

When I bit off more than I could chew

But through it all

When there was doubt, I ate it up… and spit it out.

The record shows, I took the blows.

And did it, myyyyyyy waaay.”

That’s my journey, enjoy yours.

Alzghoul, Hamza.