Page 1 of 6: Experience: A Tale of two 9s (99) in USMLE Step 1

AshB · Credits: 41453 My Scrapbook My Reading List 6 Books

"The heights I have achieved is by standing on the shoulders of my predecessors" - Isaac Newton.

I realize how difficult it is to put it in words what I think about Step1 preps so it might turn out to be long and boring story. I apologize in advance..

Step1 is a multifactorial process with lot of different possibilities and ways to approach it. To get a 99 take the approach that you are most comfortable with, rather than blindly following anybody who got a 99.

Disclaimer: I’ll state here what I did to score well, but I sincerely advise you to think twice before following me cos I’m a very careless and lazy guy and my methods are often not too acceptable and practicable for all. As few of my friends put it, its more of what NOT to do for USMLE .. LOLzz..

Time needed:
Due to certain reasons my preps spanned a period of 10 months with long breaks in between. But when I calculate it was probably equivalent to 4 months at 4-5 hours a day. I personally think 5-6 hours a day for 4 months is enough for good preps.

Books:
- Kaplan notes 2000 edition for Micro, Immunology, Physio, Gross Anat, BH, Biochemistry
- BRS Pathology , Ethics and Physician Patient Relation chapters from BRS for BH
- High Yield- NeuroAnatomy
- Goljan Audio for 3 systems. Wanted to do more but couldn’t due to time restraints.
- First Aid (FA)

I advise you to be thorough with whole of FA. It’s REALLY a great book.

Kaplan is good for all. But Behavioral ‘notes’ I found a bit lacking. BRS BH is better in some aspects. Even the gross anat part I found too concise. Many of the questions I had on step1 from gross anat, however few, were outside the material in Kaplan.
BRS Pathology is very good and provides all the required material

Biochemistry Kaplan is enough if we consider material but sometimes I feel Lippincott does a better job explaining things. Biochemistry needs a LOT of cramming and so I guess its better to read something that states enough facts and explains well too. So Lippincott, though slightly more time consuming, might be a better option, specially if you are weak at cramming.

Kaplan’s Pharmacology is good but not great.

HY NeuroAnatomy is one of the best rated resource by FA. But i found it the worse. Its a good collection of high yield facts but don't expect it to explain anything and i found that annoying cos neuroanat is not about cramming. Read HY if you have a good background of Neuro or after reading from Kaplan (I don't thin you'll need to see HY after reading Kaplan)

Approach to different Subjects:
Gross Anatomy : One of the low yield subjects. Don’t waste too much time on it. Mostly questions pertain to Nerves of limbs and MAJOR vessels like axillary, Celiac axis, femoral etc. Histology is important specially the cell structure and cell junctions.

NeuroAnatomy:
One of the highest yield subjects. You’ll find a lots of questions on it during your exam. Work hard on it. Pay special attention to:
- Spinal cord tracts
- Diseases of Spinal Cord
- Brain Stem
- Cranial nerves
- Anterior/Posterior/Lateral views and structures of Brain stem

CT/MRIs: The no of radiographs on the exam is continuously increasing so be prepared. Don’t miss any of the following:
1. Axial/Sagittal/Coronal, Inferior views of Brain
2. Carotid Angiogram
3. Transverse section of Thorax, abdomen and spinal cord
I could not find any good source of high yield MRIs. Though you can try to google Brain MRIs and you’ll find quite a few decent ones.

Embryology:
Kaplan’s embryology is incomplete. But I guess if you combine Kaplan’s embryo with FA, it’s a great combination and more than enough for all questions.

Physiology :
It’s a pretty low yield subject in the sense that very few questions would be directly from Physiology . BUT many questions from other subjects will include something that you’ll be able to understand if you know your Physiology basics. So my suggestion is take your first reading of physio very seriously but don’t take too much time cos its very low yield as far as direct questions go. The high yield topics include Hemodynamics, Respiratory and Renal.

Biochemistry :
I was and literally am still scared of this subject cos it needs very good cramming of pathways. Specially the comprehensive pathway that FA has given should be on your tips. Specially where two pathways join each other. Don’t miss even a single reaction from the vitamins, they are too high yield. The explanations of UW I found very good for Biochem.

Genetics:
Very high yield and high scoring at the same time. Kaplan’s is good enough and Lippincott’s is great too. Be prepared with questions that’ll rack your brains based on your understanding of genetics. Pedigree analysis for simple disorders is also important.

Microbiology :
Gross micro is toooo low yield. Don’t waste your time on it. I wasted 15 precious days intensively studying the whole micro. I think the material given in FA is more than enough. The only part you should know is to identify the organism based on Gram staining, morphology (cocci/rods/commas, clusters/chains), motility etc which can be easily accomplished using FA charts etc. The chapter on comparative Microbiology in Kaplan is good in this regard but not necessary.

Immunology:
VERY high yield. You should know all that is given in Kaplan and FA. Don’t miss anything from Immuno cos you’ll surely have a large number of questions on it. Specially the list of Interleukins given in FA is indispensable.

Pathology :
Of course about 50% questions on Step1 are directly or indirectly from Pathology . I just did BRS and I think it was more than fine. Unfortunately I couldn’t complete even BRS.. But then I think USMLE patho is something that can be substituted by your knowledge of clinical subjects. Becos rather than being hardcore Pathology , its more of clinical patho based on etiology, symptoms, diagnosis, variants etc. I didn’t even care to revise most of patho cos the important points that need revision are beautifully given in FA. The only chapter I’ll specially recommend to be thorough with is Renal system.

Goljan audio is just awesome, though I could just listen to 25% of it. But if time allows do listen to Goljan audio. He’ll give you fundas that you’ll probably never grasp otherwise. His sheer wit and simplicity makes him arguably the best teacher I’ve come across.

Pharmacology :
High yield subject that needs some decent cramming. Specially important are specific adverse reactions and major interactions of important drugs. Don’t start cramming every drug you come across. Just the major drugs’ interactions. And focus on class rather than individual agents.

UW has good questions and explanations on it. There were a couple of questions on newer drugs like Fenoldopam but I guess such questions are usually simple and they give enough hints to reach an answer.

Behavioral Sciences:
Ironically, this subject was a bane for me and it proved to be my undoing in my actual exam too. I performed worse on it. I did Kaplan mainly but the questions, specifically from ethics and physician pt relations are so ambiguous and confusing that no amount of study helped me.

I think BRS BH is much better than Kaplan in most aspects. Read and practice very carefully the questions on ethics. UW’s ethics questions were good but I guess not enough for me..

Question Banks:
- I did not do Qbook
- I just did the questions behind every chapter of Kaplan except patho.
- I used UsmleWorld (UW) and found it good. The questions on actual exam were of similar level as that of UW though the pattern was quite different. UW questions mostly test your knowledge of facts while I felt the actual exam tested more of your understanding and grasp of those facts.
- Specially, the pharmac, Biochemistry and BH questions of UW were pretty good.
- It is said that add 30 to your cumulative UW score to get actual Step1 score. I got a cumulative of 69% on UW so I guess the formula is close. But for that use only random/unused questions mode.
- I continuously altered my line of preps based on my performance on UW. I read the explanations very carefully that’s why it took me a long time and I could do only 1300 questions out of available 1800+
- Kaplan Qbank is also good but I did not use it.
- But finally the major factor that I used to make my preps more focused was NBME’s self assessment test (CBSSA). I took them twice, once after first read (around 28 days before exam). 2nd time about 5 days before actual exam. I specifically took NBMEs very seriously cos they’re said to be the best predictors of your performance on actual exam. I'm a strong supporter of using NBME's tests during your preps.

USMLE CD: It has relatively simpler questions but read them very carefully cos the actual questions will be EXACTLY ON THE LINES of those, just a bit tougher though. Many people get 2-3 questions on actual exam from the CD itself (even i did) so don't forget to do it. I got 44-42-45 on it.

My Schedule:
- I read 80% of the course over many months with lots of breaks.
- Then fed up with it, I started with revisions and took my exam after completing 60% revision (mostly of the topics I thought were tough and leaving whole of Physiology and Gross Microbiology cos I had realized by then that they were very low yield.)
- I had subscribed UW 2.5 months before the exam and tried to do a few questions every day. I could complete only 1300 questions.
- I took NBME form 2 after my first read and scored 218.
- I started FA seriously and did whatever I could in the short time I had.
- I focused my revision on topics I had decided were high yield and I knew I was weak at them or they needed some cramming. I also seriously analyzed my performance profile given by NBME after its CBSSA and worked hard on topics I had performed poorly on.
- Took Kaplan simulated 8 days before exam and scored 78%
- Took NBME 4, five 5 days before exam and scored 236.
- Spent the last 3-4 days reading FA or the topics on which I performed poorly on NBME.

Strategy of answering Questions:
- I'm not a supporter of the notion that says jump to the last line of a long question, specially cos USMLE guys give real crafty questions.
- I think every line 'might' have some clue to the answer. I never missed reading a single line. Whenever i tried jumping to the last line, i had to reread the whole question again.
- Compare the advantage of completing the question early vis-a-vis getting it right.
- Always pay attention to age, sex, race etc. They are many times the most important clues. Most questions would ask you 'Most likely' answer and thats why these facts become more important.
- If you find a question/option strange or too tough, just select any option and move on after marking the question. It might be the so called 'experimental Q' that are not scored. I committed a mistake of getting too involved with such questions.
- I could complete most blocks in time except two where i got stuck with such questions.
- Practice time management in blocks with your question bank.

The BIG DAY
Just a few quick things:
- The day before I just relaxed and read a few important lists and material that I had pre-decided but only until 5 pm. After that I just had fun and a good night’s sleep.
- On exam day tried to stay very cool and calm.
- Took my first break after first two blocks, that too only of 5 mins., then increased the break time progressively as I found my mind demanding more rest
- In every break I ate a chocolate to get the badly needed glucose and caffeine
- Had a coffee and a caffeinated energy drink during the breaks after my 4th block but this too much caffeine wreaked havoc on my kidneys and I was on the verge of overflow incontinence during my last block. Thankfully I came out dry.. LOL
- Just don’t lose your cool no matter how hard you find it. Relax and take a few deep breaths when you feel flustered.

When I came out of my center I felt wretched and depressed even though I knew it happens with everybody. The exam would never let you feel confident so don’t worry and just try to do your best.

My impression of Step1:
Its more of a test of IQ. You’ll get quite a few hypotheticals and questions needing abstract thinking. The most important thing is your understanding of the bigger picture rather than minor facts. It is important to develop an approach towards solving questions and that’s where good Qbanks become important. Read the explanations very carefully and improve your preps based on inputs from them.

My take on edition issue:
I think its total crap. You can score equally well even with 1999 issue. Minor facts and inclusions are of no value and never affect your final score. I, for example used 2000 Kaplan notes.

My take on coaching:
Advantages:
- Helps you develop that perspective that is needed for step1
- Helps discipline you (I really wish I had joined Kaplan due to this reason

)
- Motivation
- Of course good study material and good environment

Disadvantages:
- Time consuming, hence you can’t get on with your steps fast
- Quite expensive
- Can depress some rather than motivate
- People ‘might’ get misguided into reading unnecessary material cos of intense performance pressure created there. I stayed with my friends for a couple of weeks who were taking step1 coaching at Kaplan. I tell you, when I look back, half of the things they used to discuss seriously were useless and very low yield for the exam.

Finally a big thanks to all on this forum for their cooperation, wishes and encouragement. I hope not to repeat my mistakes and hope for a better 3 digit score on CK.

Good luck to all..

Any further questions are welcome..

drche · Credits: 11879 My Scrapbook My Reading List 10 Books

hey Asheesh,
congrats man!!! way to go!

all the best with the next steps as well..

muba · Credits: 2705 My Scrapbook

hey doc!

congrates!!!

impressive job!

Whiterose · Credits: 1896 My Scrapbook My Reading List 8 Books

FANTASTIC GUIDANCE ASH B.
N CONGRATS FOR 99.

ieltsforall · Credits: 2074 My Scrapbook

To AshB BHAI hi and how are you first of all congratulation of your not good success but your AWESOME succ

ess.
God will give you each and every your destination what you desire on your life .
Another thing your post is not as such impresseive as anyone expect because your every post gives us alot of proper and alturistic guidance so i can firmly say your this post is another further contribution of your another AWESOME post thanks alot and all the best

Siyaa · Credits: 8168 My Scrapbook My Reading List 1 Books

ASH

THANKS A LOT

pass_usmle · Credits: 1388 My Scrapbook

Hello there AshB,
Wow what a great score.
Guys AshB proves it yet again. He is the best be it, advising, moderating, helping or SCORING!!!!!!!!!!
Congratulations on the terrific achievement. I wish my score could have been comparable to yours but alas.....
I really liked the prep review...so detailed and nicely written. Good work dude!
I pray to the Almighty that you get the same terrific score in all the remaining steps.
By the way....wheres my share of the celebration cake????

Bye for now.

saba01 · Credits: 223 My Scrapbook

HI ASH-B
TO EXPRESS OUR FEELING ON YOUR BRILLIANT SUCCESS HERE IS A DEDICATION,

CONGRATULATIONS , you made it!
i always knew you would
there is a star in the making
look out world!
whether on mountain top,'
or in a valley low, you will always
make it through the storm
& find a rainbow !!!

You are among those nice people I found on this forum who always extend helping hand .I pray you stay the same forever ,MAY GOD SPEEDS YOU

medisid · Credits: 4715 My Scrapbook

congrats Asheesh............
may u repeat the performance in CK too.
best of luck for future!!!!

Cricketer · Credits: 404 My Scrapbook

This was a really well written experience Ashb. I've been going through lots of experinces on the net and came to rxpg searching for more, but this one certainly stands out. I feel pretty confidenct after reading this that even i can do it. Congratulations on your 99. How do you manage a 99 as well posting so much on the forums, just curious.

I will pester you with more queries later. For now just tell me why did you leave what you left from the study material?

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