My Step 1 experience- 254

Rohan Desai
NHL Municipal Medical College, Ahmedabad
India.
drrohan.desai@gmail.com

About me:
I moved to India after finishing high school in the U.S in 2012. Knowing that my
goal was to take the USMLE, I focused more on building concepts rather than
rote memorization during my MBBS. Despite averaging just 70% on my
University finals, I was determined to cross 250 on my Step 1.
The initial plan was to finish the test by Dec. 2017, but juggling internship and
studying effectively did not work out. I ended up taking a break from internship
from Feb 2018- July 2018 to study full- time (~12 hours/ day).

Resources:

What I used: (Using so many resources was a HUGE mistake.)

1. Kaplan Books and videos
2. Boards and Beyond (neuro, renal, social sciences, parts of cardio)
3. Anki flashcards (Zanki deck)
4. Pathoma videos and book
5. FA (switched to latest version when it came out in January; recommend
everyone to do this no matter how painful)
6. UWORLD
7. USMLE Rx
8. Kaplan Qbank (ethics/ behavioral)
9. Goljan audio lectures
10. Goljan Pathology book
11. Sketchy (Micro, Pharm and Patho)

These were all the resources that I studied significantly from but I also spent a lot
of time looking at things like USMLE Rx videos, DIT lectures, DirtyUSMLE etc.
The various resources made me feel overwhelmed and lost more than anything
else. I highly recommend against doing what I did.

What I should have used:

Tip 1: Kaplan is ridiculously overrated. I know everyone thinks they don’t

remember anything from the first 2 years and their concepts are weak etc. Yes
that might be true and yes you need to go more in depth than what FA has.
Absolutely true! KAPLAN IS NOT THE ANSWER. Unless you plan to keep
reviewing these books every time you go through the topics, one of two things
will happen:
 1. You will forget all those old concepts Kaplan was meant to reteach you by
the time you come to UWORLD and NBMEs. Kaplan takes close to 3
months easily.
2. You will annotate your FA into oblivion and turn it into Kaplan. The details
are not high yield enough and FA and UWORLD is definitely worth more
your attention.
So what do you do to refresh all those forgotten concepts?
Boards and Beyond. The videos go more in depth than FA does, but still
manage to stick to most of FA. They are exceptional for topics like stroke and
ethics and add more to FA that is actually tested in UWSA/ NBME/ actual test.

Tip 2: Since the moment you think about doing USMLE, start doing Zanki deck.
Download the app Anki (free on android and desktops, $25 on Iphone). Spaced
repetition of all the systems you do. THIS IS THE SOLUTION TO FORGETTING.
It takes a lot of time as you progress but the best part is that it is active learning
that has pathoma concepts and images, UWORLD concepts and tables and
Sketchy pictures included. There are ~16 thousand flashcards, but this resource
is good enough to replace multiple readings of FA.

Tip 3: Pathoma videos. Watch them multiple times. It is great and all that is
necessary. Goljan is too big to keep reviewing, so don’t waste time on it. Goljan
audio lectures are light hearted and still give a lot of new information and ways to
approach the questions.

Tip 4: FA- latest version always. The book is created by asking students about
their tests. This is equivalent to standing outside of each test room and asking
people what was on their test. Do not give up on this opportunity because of
money or inconvenience of changing books.

Tip 5: UWORLD- tutor mode, system wise 1st time. Make notes in a separate
notebook. Write in bullet points and not an essay. Read the right and the wrong
with equal intensity. This is where 75% of your concepts will come from. FA
provides facts; UW integrates into concepts. Do this 2 times minimum. If needed,
do it more times. This can only be good for you. (2 of my questions on the actual
test were verbatim from UWORLD). The notes and the tables are essential.
Memorizing them will be supplemented by Anki.

Tip 6: USMLE Rx: Not essential. Use only in cases where despite doing
UWORLD and FA, certain things are still not clicking. (ex. Heart sounds/ ECGs/
arrhythmia questions still throw you off after doing UWORLD and learning FA)

Tip 7: Sketchy: If you are a visual learner (remember some random episode of
Friends or House like you watched it yesterday) then this is a phenomenal tool.
Don’t take it too seriously. Watch it when you are chilling, have some down time
and are just bored. Listen to the stories and just focus on that. The learning will
happen subconsciously. I utilized sketchy for every subject; absolutely loved it. It
is not for everyone however, especially pharm and patho.
Please do not try to reinvent the wheel like I did. UFAPS absolutely works. You
will be able to answer 85-90% of the questions on the test. Don’t be frustrated
and lost like I was.

Resources YOU should use:

1. Boards and Beyond videos (B&B)
2. Anki- Zanki
3. UWORLD
4. FA
5. Sketchy
6. Pathoma

The schedule:

Phase 1:
1. Start with Boards and Beyond. Watch the videos and try to understand.
Sketchy for micro. Pharm and patho according to preference.
2. Read the corresponding FA pages. Add what you need to in another book.
Keep FA as clean as you can.
3. Do the corresponding questions from UWORLD. Annotate in a reasonable
manner. The average on each block does not matter one bit. Do not be
disheartened if you are scoring low or very very low. It’s a learning tool.
4. Move onto the next system; start with B&B videos.
5. Every evening, review 5 pages of FA from previous system. If doing
Zanki, just stick with Zanki (this is where the difference will come
between people that read FA 2 or 3 times vs someone that reads it 7-8
times).

Phase 2: (all systems are covered, every page of FA highlighted, UWORLD

completely annotated)
1. Take your first NBME (13 if you plan to take all of them, 15 or 16 if you
don’t.)
2. Read FA and notes cover to cover- this will take approximately a month.
THIS IS WHERE ACTIVE EFFORTS TO MEMORIZE SHOULD COME
other than Anki.
3. Take NBME 15.
4. Analyze the breakdown. (Pick 2 or 3 of your worst performances and
focus on them over the next 2 weeks.)
5. During the 2 weeks: Do whatever you need to, to completely understand
and memorize these systems. FA, anki, rewatching Pathoma, sketchy etc.
No stone should be left unturned. This is where additional Qbanks like
USMLE Rx and Kaplan come into play. Goal: get a star on those 3
systems in the next NBME.
 6. Reset uworld and start 2nd pass. Timed random mode. This will help
maintain your scores in all the other systems that you are not reviewing in
the 2 weeks.
7. Take NBME 16; repeat the cycle. Take NBME NBME 17 in 2 weeks. Try
to shorten the duration between each NBME. Do a minimum of 1
UWORLD block a day. Target- >90% average on blocks.

Phase 3: (4 practice tests left- 18, 19 UWSA 1&2)

1. Your block should be starting by the time you take UWSA 1. You should
be within striking distance of your target score. You don’t need to feel
confident about the test, but your NBME scores should be something that
you can live with.
2. Now it’s time to take the leap. Take UWSA 1. It has an extremely
generous curve but the question length and difficulty is very close to the
actual exam. Treat it like the real test. Replicate D-day as much as you
can, from the food you eat to the time you take in each break.
3. Analyze and work on your weaknesses.
4. Start replicating test days and doing simulation exams. USMLE Rx is a
great resource for this because they have an option to simulate full tests.
Take 1 full test per week from now on until the actual test.
5. Take NBME 18 within 7- 10 days.
6. Take NBME 19 within 7-10 days.
7. This will be your last read of FA and notes.
8. Cross your fingers and take your date. Keep in mind that it is hard to find a
date for the next week.
9. Take UWSA 2 a week before the actual test date. Follow the 4 blocks of
UWSA 2 with Free 120. Treat this like an actual test. Start the test by 8
AM and monitor your breaks (give yourself just 45 min instead of 1hr) and
your food.

My Scores:
NBME 13: 225
NBME 15: 236
NBME 16: 234
NBME 17: 240
UWSA 1: 271 (couldn’t believe it either; felt amazing to break through the
plateau)
NBME 18: 255 (brought back to earth but I am not complaining)
NBME 19: 242 (WHAT??? Don’t freak out. Between 18 and 19, I only had 1 more
question wrong. The curve is just extremely steep.)
UWSA2: 260

UWORLD 1st time (tutor random mode- mistake)- 65%

UWORLD 2ND time (timed random)- 92%

The day before the test:

Drove to the center to familiarize myself with the drive. Voice was cracking, body
was shaking and I was just shy of having a panic attack. Listened to bunch of
pump up music. Got to the center. Sat outside and just visualized myself doing
well in each block. Helped me a lot to calm down. I ended up reading till 10 at
night the day before the test and I absolutely regret it. This will bias your answers
on the day of the test and you will be more mentally fatigued. Do not do this.

EXPECT TO NOT SLEEP THE NIGHT BEFORE. Had been training myself to
sleep from 10-6 for a month, but the night before I woke up by 1. Drifted in and
out of sleep till 5 and then just gave up.

Test day:
Drove to the center listening to my pump up music. Reached 10 min before the
center opens. Meditated and visualized to calm myself down. Started my test by
7:30.

The staff is awesome and very accommodating. Check your earphones and start
the test. It looks exactly like UWORLD. Just tell yourself you are doing yet
another block of UWORLD and that’s it. 1st block is definitely very intimidating but
they aren’t necessarily more difficult; just 7 blocks of new UWORLD questions.
Stay calm and don’t waste too much time on any one question. You don’t know
which one is experimental.

I tried to attempt all questions within 45 minutes. I marked ~ 13 questions in each

block in the first round. The next 15 minutes I would only focus on those
questions and was able to narrow it down to 8 marked by the end of the block.

I took breaks after every block. I would run to my locker, drink lemonade and eat
an energy bar while running to the bathroom. Use the bathroom and splash some
water on my face. Tell myself I am killing this and run back in. This entire
process, including signing in and out, took 7 min minimum. I took a 10 min break
between block 4-5 and 5-6 and 15 min between 6-7. I was still left over with 5
min of break time.

The test was definitely difficult and there were quiet a few options I had never
heard of before. Overall I felt like ~85% of the test was from UFAPS.

Advice:
1. Meditate/ visualize doing well on the test every day. This test is as much
about knowing the material as it is about being able to recall and apply it
at a key moment. Being calm under such immense pressure requires a lot
of practice. Knowing all the material will be no good if you cannot calmly
process the question.
2. Do not read the entire question from the top to the bottom. Always read
the last 2 sentences first. A lot of times there’s a huge vignette at the end
of which they tell you the patient has malaria and ask you the side effect of
 choloroquine. No point wasting your mental capacity analyzing the
vignette. Read the whole thing if the last 2 sentences aren’t a dead give
away; also for mental satisfaction after you have answered the question in
15 seconds.
3. DO SEVERAL COMPLETE TEST SIMULATIONS. Even if you and
someone else have the same amount of knowledge, there will be a
significant gap between your scores in the last 3 blocks vs theirs. Silly
mistakes are equal to mistakes due to knowledge gaps. Building
endurance is the best way to avoid such silly mistakes.

Best of luck. Do not lose hope. If not you, after all the sacrifices and hard work,
then who? IT HAS TO BE YOU. IT WILL BE YOU.