In the name of God, the Most Gracious, the Most Merciful

I’d like to present to you my humble step 1 experience; but first, allow me to introduce myself.
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I’m Ahmed Samir, an Egyptian International Medical Graduate (IMG) in the 6 year (the final academic year) in
Kasr Al-Aini School of Medicine.

I believe that there is no perfect human experience, that is why we are different from each other so that we can
learn from each other; and because of this, I’ll try to focus in my experience at the weakness points & the mistakes
I made, so that you avoid them when it counts. And it’s important to mention also that I won’t be adding anything
new here (all the stuff included here I believe you read or heard about somewhere else before); these are all the
advises from my study partner, friends & others who took the exam before me; all gathered in one place. Another
point to mention is that everyone has his own experience & there is no complete source that has everything, so try
to make your own, cause what I’m saying here & stressing on the fact that what worked very well for me, may not
work for you & vice versa; So the most important take-home message is “Choose what works for you best & stick
to it, No one is gonna do that for you”.

But before I start, and to make it organized, I wrote down below the sections that will be included in this detailed
talk.

Contents :-

1- Abbreviations used
2- Preparation period
3- Sources used
4- Extra sources used
5- Rapid Review Pathology by Dr.Edward Goljan
6- Doctors in Training (DIT) 2015
7- UpToDate, Wikipedia, Google images…etc
8- YouTube channels you don’t wanna miss
9- Mood fluctuations & burnout during preparation
10- Questions Banks
11- First Aid for USMLE Step 1
12- NBMEs & UWSAs
13- Last 2 months
14- Last month
15- Last week
16- Last day before the exam
17- Day of the exam (from A to Z)
18- Feeling after finishing the exam
19- Weakness points
20- The “DO”s
21- The “DON’T”s (AKA Don’t repeat my mistake)
22- Pages you need to review from Dr.Goljan’s
 23- Dr.Najeeb’s lectures (& when to use them)
24- Summary
25- Acknowledgment
26- Final Word(s)

I know that this is too much, but it’s on purpose, as some people may benefit from the small details. And to those
who don’t have the time or can’t read all this, you may check the summary or you try to have a quick look at
sections 8, 9, 19, 20, 21 & 22 (the ones in red).

So, here we go! 

1) Abbreviations Used
- IMG: International Medical Graduate
- FA16: First Aid for USMLE Step 1 2016
- NBME: National Board of Medical Examiners Self-Assessment
- UW16: USMLE World 2016
- UWSA: USMLE World Self-Assessment
- KLN: Kaplan Lectures Notes
- DIT: Doctors in Training
- Micro MRS: Microbiology Made Ridiculously Simple
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- DSM-IV: Diagnostic & Statistical Manual – 4 edition
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- DSM-5: Diagnostic & Statistical Manual – 5 edition
- BRS: Board Review Series
- SP: Study Partner
- ttt: treatment
- CIN: Candidate I.D. Number
- IM: Internal Medicine

2) Preparation Period
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Day I started: 9 April 2015
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Exam Date: 19 February 2017
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With a lot of interruptions (you can never imagine; most of my preparation was in my 5 academic year,
where we study Pediatrics & OB&GYN + interruptions during school exam days), so you can cut down
these, almost, two years into half!! So it took me about 12 months or so.
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Got my result at: 8 March 2017 (2 weeks & 2 days after the exam)

3) Sources Used
Nothing new here, I used the traditional sources that everyone knows; I watched the topic from Kaplan
lectures of 2010 (personally I prefer them over 2014, cause they explain every fact, while 2014 goes over
the high-yield mostly & very pressurized) & studied it from Kaplan Lecture Notes (KLNs).
The order which I went through the disciplines is as follows (I would recommend it because it allows you
to build a solid foundation):-
1- Histology & Anatomy: the 2010 lectures were kinda boring, but they are to the point, so you may
speed them up. The Neuroscience part was the best in the lectures as far as I can remember.
 2- Physiology: Oh well! It’s Conrad Fischer “The Fish” (in 2010 lectures), one of the most AMAZING
COMPASSIONATE teachers you will encounter in your whole life, I’m sure of that. I don’t need to talk
more about him; just listen to him & prepare to be impressed. Also there is Dr.Wazir Kudrath (in
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2010) & he was the 2 best after The Fish in the discipline; I didn’t watch Dr.Wilson (in 2014 lectures)
so you may try him yourself.
3- Biochemistry & Genetics: the 2014 videos were great for me, & I loved the great Dr.Sam Turco who
makes it very easy & smooth for you to understand & memorize; so finally, “IT MAKES SENSE!”; he is
in 2010 lectures also, but not as interactive & enthusiast as in the 2014 classroom. You may also don’t
wanna miss Dr.Lionyl Raymon lectures in 2010, he is simply outstanding in biochemistry & pharma.
The genetics part was very new to me, but it was very well written & explained in KLNs, so by time it
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became integrated with the biochem part. I would recommend that you start with the 1 7 chapters
(which talk about molecular biology; DNA, RNA, and that kind of stuff) & then move to the genetics
part, to integrate it with the molecular biology while you’re still fresh & then finishing the metabolism
part in the biochem which in my opinion was the easiest, less detailed, part. Don’t save any hard
material to digest, annoying or exhausting part for last! Try to finish it early as by time you might get
bored & less energized; So it would be best to save the desserts (easy topics) for last.
4- Microbiology & Immunology: I watched 2010 lectures, in their order, starting with immuno & then
micro; Dr.Kim Moscatello was very good in immuno & I liked her simplifying animations very much,
but sadly that wasn’t the case with me in micro, so I read most of Micro MRS to understand the
nature of very organisms very well; and at the end, what you’ll find in FA will be enough for your test.
5- Pathology: I did it from Pathoma (lectures & videos); for me Dr.Husain Sattar in patho is like
Dr.Fischer in physio in simplifying things & the passion they both have while teaching (though they
differ in their way of teaching); Teachers like these you get the chance to learn from them only once.
Later on I did Rapid Review Pathology by Dr.Edward Goljan (will talk about that later)
6- Pharmacology: I did it from Kaplan 2010 lectures; Dr.Raymon (mentioned him in the biochem part) is
simply outstanding in explaining every bit of a detail to make all these drugs an easy game to play at
the end.
7- Behavioral Sciences: Kaplan lectures 2010 as well; whatever happens, don’t try to miss Dr.Steven
Daugherty, either in biostatistics & epidemiology or in the psychology & psychiatry part, though you
may have to have to be updated in the DSM chapter, as he explains facts in the DSM-IV while the
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latest edition available now is the 5 edition or DSM-5 (DSM is sometimes called “The Psychiatric
Bible). He will give you an endless number of examples from real life to make such a whole new
subject an easy thing to apply in your real life; We don’t have this discipline detailed in our school like
here, so if you’re like me, I’d recommend sticking it between biochem & micro to avoid the burnout
part, you may get at the end, as I mentioned before.
Anyways, I’d feel that this is a good logical order to build your foundational hierarch (starting with the normal
anatomic site, normal function & ending with the disease/malfunction & finally treatment of that disease) that’s
how it worked well with me.

Overall, I did KLNs 2 times & Pathoma book 3 times.

 4) Extra Sources Used

I didn’t go through all of these sources, but I referred to them whenever needed during my preparation; so I’ll
focus here on the chapters or topics that you should have a look at if you don’t have time to read all of ‘em.
1- Anatomy Self Notes: this is a .pdf file that contains about 200 slides of the most important & high-
yield clinical anatomy facts that you need to know. I think you may find it uploaded here on the
group. Don’t miss them; they’re full of colored pictures & less words, so they are easy on the eyes.
2- Microbiology Made Ridiculously Simple: Such an amazing underrated book in my opinion; It’s full of
childish drawings, mnemonics & tables that stick the bugs in your brain like the names of your family
members, lol. It’s written in a casual way as if a friend of yours is explaining a topic to you, not that
formal boring way that is in most textbooks. I read all the bacteriology, fungology & some of the
virology in it. The book is about 400 pages, so if you don’t have the time to look at it or your exam is
too soon, try to look at the tables at the end of each chapter (very very organized) & the bacterial
genetics chapter (I understood it only from here; the best chapter ever written in this book) & the
antibiotics topic (this one is a plus or minus thing to do).
3- BRS Physiology: this book made physiology such an enjoyable subject; written by Dr.Linda Costanzo in
a bullet point format (like in Pathoma) simplifies what you need to know about physiology very much;
the only defect in this book is that it lacks graphs (unlike KLNs in physio); if you don’t have time to
read all of it (about 220 pages; I went through most of them), you may read the Neurophysiology
chapter, as it is not present in KLNs.
4- Robbins & Cotran Atlas of Pathology: Such an AMAZING atlas, it has everything you can ever imagine
about Pathology & Pathophysiology with detailed explanation of what is going on in the slide or gross
specimen you’re seeing. I used it a bit extensively during my final month of preparation.
5- CTs & MRIs of brain & spinal cord: I reviewed them from High-Yield Neuroanatomy book; it’s full of
imaging pictures that are deficient in KLNs. I didn’t read the book itself, only did the imagings.
6- Netter & Gray’s Anatomy Atlases: I reviewed some anatomy & muscles I forgot from these 2 atlases.
Visuals are always a great way of learning, instead of reading lots & lots of plain text!

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5) Rapid Review Pathology (4 Edition) by Dr.Edward Goljan

The Pathology Hulk, written by Dr.Edward Goljan (go search for his audio lectures; Old but Gold); this
book is about 730 pages but it’s worth it; every page, every picture, every table, every pathophysiology &
every integration is a treasure; If I allowed myself to emphasize how great this book is, I’m sure I won’t
finish!! The pictures are very detailed like what you might see on the exam & the explanations (especially
the pathophysiology) are similar to the ones in UWorld; the approach I did through this book & I believe
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it’s the best is that I would go through the chapter in Pathoma first (did that during its 3 read) & then
read it from Goljan’s, so that I’d filter the new facts & diseases from the one that I already reviewed in
Pathoma & the whole book won’t look all new & exhausting after that. It took me about a month to finish
it using the approach I described above, but that’s because I’m a bit slow in reading; if you are fast, it may
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take about 2 weeks or so to finish it for the 1 time (that what happened with my SP). I used it later as a
powerful reference to understand facts that I may face in my FA; Guys, this book is just the pathology part
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in FA very well explained & organized. If you’re planning to read it a 2 time (which I didn’t do) you may
go quickly through the blue margin notes as they contain the high-yield facts that you may get asked
about. If you don’t have the time to study it, you may need to review some topics, I’ll mention them in
section 22, that are not in Pathoma or any other source; but personally I predict that this book will
become a must, by time, as the exam is getting deeper & deeper in asking about fine details each year.
 6) Doctors In Training (DIT) 2015
DIT is a series of videos (each one is about 20 min or so) that explain facts in FA & extra facts in UW that
are important & get tested; It’s like reviewing FA, but in videos. They’re about 80 hours, and I got used to
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watch them during my 5 year final exams; the exams were during the whole Holy Month of Ramadan &
reviewing notes or books would be very devastating, as studying my school curriculum for the exams were
taking most of the time.. & glucose; so I would watch about 1.5 – 2 hours daily during the month 2 or 3
hours before the breakfast (the time when your eyes & brain are completely tired & you become
hypoglycemic) at speed of 1.5x; I finished the series about 10 days after I finished my finals. I also took
some notes & screenshots of tables, mnemonics & illustrations & annotated some in my FA. All of this was
my SP’s idea, so thanks to him. You may watch ‘em during your exams or any period of boredom (they are
very funny & the video is about 20 min, so you won’t get the chance to become bored at all); I liked
Dr.Mike McInnis & Dr.Chris Lewis, and the rivalry between them, very much; I also liked Dr.Jennifer
Shuford’s micro lectures, as they were very very simplified & strict to the point.

7) UpToDate, Wikipedia, Google images…etc.

These sites should be your companions during your journey of preparation;
- UpToDate: my SP told me about it (thanks again to him); such an amazing resource that you won’t
ever regret using. It’s very detailed & simplified at the same time. Each topic is presented in all its
aspects: starting from the Definition & Epidemiology & finishing with a Summary & Differential
Diagnosis. It’s a lot better than Medscape & the you can find in the same topic a whole collection of
images (gross, microscopic, imaging, curves), tables, algorithms that collect the most important
information facts you need to know about the disease and, of course, It’s up-to-date. You can kinda
think of it as a UWorld explanation, as they’re both written in the same manner, and of the Summary
as the educational objective (what you really need to take home with you & never forget)
How to Use it: if you have a specific topic in mind that you need to know more about or a topic that
you were asked about in UW or an NBME i.e. Cystic fibrosis, search about it & then inside the topic
jump directly to the Summary (which is written in about 9 – 10 bullet points), mostly you’ll find your
answer there; If not, you may search for the keyword you’re looking for using the “Ctrl + F” or you go
directly to the investigations, ttt or whatever you’re looking for, and you’ll find your answer there.
Warning!: Don’t get into depth as you’ll find too much details & trivia (compared to other important
high-yield facts) & you’ll end up spending the whole day reading about 2 or 3 diseases & knowing
stuff that may not be important, at all, in the meantime; So, try to control the details & don’t allow
them to control you & manage what you’re looking for properly.
- Wikipedia: our friend in all the situations; mostly you’ll end up using it to have an idea about a test,
investigation or a small topic that you don’t want to know much details about.
- Google images: use it, always, to look at diseases pictures, pathways…etc. My main use of it was to
look at pictures of skin diseases; I tell you “If you don’t look at pictures for every single disease in
Dermatology, then you’re wasting your time”; It’s a very volatile branch & I don’t know why!
There were other sites I didn’t use, like Radiopedia, Webpath; You’ll find tons of them; but the ones mentioned
above (+ YouTube) were enough for me.

8) YouTube Channels You Don’t Wanna Miss

We all use it of course, but you won’t believe that it’s very underrated to the extent that it contains a
tremendous amount of visuals, animations, songs, mnemonics, full lectures & people from all over the world
working really hard to deliver to you the easiest explanation for a better understanding! All what you have to
do is search for the topic you want & then add the word “USMLE” to it i.e. “leukemia usmle” & I’m sure you’ll
find more that what you need there. But what is important in this section, is that I’m gonna put for you the
names of the YouTube channels that were really good friends whenever I get stuck at understanding a topic or
in some of the breaks, as changing the way of studying throughout the day minimizes the chances of boredom
& burnout; So, here are the top channels in my opinion:-
- Osmosis: contains a package full of most diseases you’ll study, each disease is in about 5 to 10
minutes-video; this is the number one YouTube resource in my opinion. Its videos are very concise,
full of hand-drawings & animations that make you understand the material & master it. Go & see for
yourselves what I mean. All their videos are for free, so support them guys; they deserve it.
- Boards & Beyond: these lectures provided by Dr.Jason Ryan, a cardiologist, are the best lectures I saw
on YouTube. He provided some lectures on his YouTube channel & the others are on his website; for
me the ones on YouTube were very enough for hard topics I met like the anti-arrhythmics, ECGs,
heart sounds, diffusion & perfusion limitations, study designs & bias, and quality & safety measures;
There are more, but these were the hard ones to digest for me. His lectures are very similar to
Pathoma’s, the same powerpoint interface & a similar style of teaching; The best for me was the anti-
arrhythmics lecture, it was very tough before & after that it become one of the easiest to understand.
Just go & watch his lectures, you’ll be amazed.
- Dr.Randy Neil: his lecture about biostatistics maybe the best that you’ll find about this topic; it’s
divided into 4 parts (total about 1 hour) & very easy to understand; you may go search for it. He also
has other videos where he applies the equations into questions & giving strategies to solve them but I
didn’t watch them. Thanks to my SP, he told me about him.
- DirtyUSMLE: this is a mnemonic bomb, it’s made by a guy who took the step & made these videos for
the hard topics to memorize like leukemia & lysosomal storage diseases. His mnemonics will make
you study these hard things in a matter of 5 minutes or a bit more; Just don’t miss him.
- Khan Academy: everyone knows it I think; they explained the heart sounds (with audio samples) in a
24-minute lecture (divided into 2 parts). You may find there more videos about other topics as far as I
can remember, but the heart sounds lecture was so great so I had to mention it.
- Anti-Arrhythmic Sickness Video: my SP partner told me about this as well. It’s a 5-minute song that
will make you memorize these drugs by heart; but you should understand them first; so the best way,
in my opinion, is to understand the anti-arrhythmic lecture of Boards and Beyond & then go for the
song.
- Armando Hasudungan: I didn’t watch much of his videos, but I liked his way of illustrating diseases &
topics in a single big picture of hand-drawing.
- 100lyric: my SP told me about it but I didn’t get the chance to watch the videos there; you may try
them yourselves.

9) Mood Fluctuations & Burnout During Preparation

I noticed that this part doesn’t get enough attention to be talked about when I read other experiences,
but we’re human beings after all; the preparation for any USMLE step takes a long time, from months to
even more than a year, so you won’t always have the same energy & power that you started with in the
first place (if you did, then you’re abnormal, seek a doctor :D), it has to have its ups & downs. While you
get deeper into the disciplines & feeling that what you memorized start leaking from your brain (which is
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completely natural, especially during your 1 read & before doing any NBMEs) & you have new info to
accommodate, you might feel a bit down & depressed, even to the point that you get burned out! You
might ask yourself each time you get these feelings: “Why am I doing that to myself?”, “Why did I choose
that path from the beginning?”, “Am I sure that I can do it?”, “Why did I put myself in such pressure?! I
 was comfortable & the school curriculum was just enough for me! Why didn’t I just stick to it?!”, “I’m not
socializing with my family or friends like before; I’m becoming lifeless!”, “My friends are spending their
vacations here & there and I can’t be with them!”… and all that kind of stuff that burns you from the
inside! Guys, there is a point of difference that has to be made here, especially for IMGs; school
curriculum & exams are an obligation that everyone in your class goes through, so you won’t feel alone
when you have a quiz or an exam tomorrow or next week; while in USMLE pathway, it’s all up to you from
the very beginning, from deciding that this is the best road for you till your Match results appear; that’s
why you’ll feel alone throughout this journey; you’ll be isolated, introverted, stay at home most of the
time, wake up early to just hold onto your schedule & avoid getting late, all of that you’ll be doing it
alone! So you have to deal with it somehow; you may find a SP who might take the exam with you at the
same time of the year or closer to, so that you can follow each other on a daily basis, challenge each
other, and discuss hard questions so that everyone knows why he got them wrong. Another way to avoid
burnout while staying at home during these months is practicing sports; find what suits you best; for me I
got used to go the gym 1.5 – 2 hours daily so that it would relieve any stress I have about the test. Try also
to find an entertaining thing to do while you’re at home so that you can save time going outside to have
fun; for me I watched all of Batman – The Animated Series & Superman – The Animated Series (almost
finished it before my exam), some episodes of Timon & Pumbaa, and some movies; the episode is 20
minutes long so it’s a very great break; I watched one or two episodes, depending on how much I needed
a break; I love animations, childish me. Try to find what works best for you & what entertains you the
most; it’s better to be something that doesn’t have reading too much in it to give your eyes a chance to
rest. It would be great to hang out with friends every now & then; no one studies the 24 hours after all!
USMLE journey is a long exhausting one; so to get the very best of it (it’s totally worth it by the way), you
have to sacrifice something! Deal with it! Nobody gets everything great in this life. And always have
support from your family & friends.

10) Question Banks

The only two question banks I did were UWorld (did it 1.5 times) & USMLE Rx (did about 2/3 of it); I’ll talk
briefly about each one:
- UWorld: one of the weapons you’ll stick to till the end (besides your FA); it has about 2500 questions,
each question has a golden fact that you can’t enter your exam without knowing it. It took me about
1.5 – 2 months to finish as I took extensive notes (in the beginning) into a separate notebook; later on
I was highlighting the important phrases in the explanation, then I took the whole screen (containing
the question, explanation & objective) as a screenshot on my tablet using a Jailbreak tweak called
“Snapper” (Thanks to my friend who told me about it); This way, I saved a lot of time of annotating, in
my own words to simplify things, and highlighted the important stuff & took a screenshot that had it
all; then it was up to me depending on how much time I had; I read the whole question, tried to solve
it by recalling (without looking at the choices), then had a look at the whole explanation (if I had time)
or just the highlighted text & educational objective only (when I ran out of time). I’ve got an overall
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performance of 68% (77 percentile) because I started the bank before I finished FA (which was a
stupid mistake I made). You cannot miss this Q-bank; try to know it by heart, especially the tables &
diagrams; very.. very… very illustrative; they save a 1000 words of explaining things (I’ll try to upload
them here ASAP once I finish organizing them). Don’t burn this bank by doing it offline! And don’t
start it early in your preparation; save it for last & do it online (as they update & add new questions
regularly each time there’s a new fact that gets asked about in the real exam). The ideas in it are
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similar to the ones tested in the exam. I subscribed for 6 months (with the Reset option) with my SP;
he finished it before me (cause he had his exam earlier) then I resettled it & did it. I know that you
 know what I’m about to say but I have to stress on it again; this Q-bank or any other one are not
assessment tool, they are LEARNING TOOLS; the only assessment tools that tell you where you stand
are the NBMEs & UWSAs; any other bank is not predictive at all, as you will encounter new
information & new facts while going through it; It’s just like a textbook written in the form of
questions; that’s all. I’d recommend that you do in “Timed Tutor” mode, which I see is the best
among all, as it simulated the real blocks & gave me the chance to manage my time during the block;
this mode starts the block with an hour to finish it, then it counts down; the countdown is on only
while you’re doing a question; after you’re done with it & gave an answer, the explanation appears &
it tells you if you did it right or wrong at the same time; while you’re reading the explanation, the
timer stops (so it counts down only while you’re doing questions), and the explanation appearance
after the choosing an answer directly allows you to associate what is in the vignette with what fact
the question is asking about & wants you to know; so that you won’t waste your time again if you
finished all questions & came back to each one remembering it again, as if you’re reading it for the
first time; finish each question (with its explanation) & move on. My recommended approach after
answering a question is reading the explanation of the right answer (even if you got the question
right, know why it’s right, cause you may got it right by chance or guessing) & the differential
diagnosis (other choices) of the right answer, especially if the topic is really new to you; if not, you
may read the explanation of the right answer only & that would be enough; then after that jump to
the educational objective & know it by heart (annotate it in your FA if you want to, but you must
know it). I was doing 1 block a day, sometimes two. An important point to mention is that the level of
difficulty of this Q-bank is way higher than what you’re gonna see in your NBMEs & real exam, so
don’t get pissed off if you did 8-10 questions wrong per block, that’s normal. I had about 15 to 20
minutes left after I finished a block. For me, this bank is really worth every cent.
- USMLE Rx: I did most of it offline (2014 version); it’s very good in the fact that asks about high-yield
facts that are more common to be tested than others & at the same time, allows you to revise &
apply your FA. So it’s the facts, in the questions, that are important & not the type (format) of
questions themselves (as they were too short & too easy).
I did some of Kaplan Q-bank in the very beginning of my prep. But I didn’t like it, it was very hard & asked a lot of
times about low-yield facts, so I had a bad impression about it. You may try it & see for yourself, it may be a helpful
one to you.

11) First Aid For USMLE Step 1

The Step 1 Bible; know it from front to back & back to back like you know your hand creases; each word in this
book can be a question topic; so, understand each topic very well & not just memorize, understand first then
memorize as much as you can. I don’t have to talk much about it because everyone knows the relationship
between FA & USMLE Step 1. I’ll just mention some tips that may help studying it more easily than usual. I
read the book about 3 to 4 times before my exam; divided it into 3 parts, each part is about 200 pages; the
first part is the high-yield general principles, the second is from the cardiology to the end of skin & muscle
chapter, and lastly the third is from the neurology to end of the book. The book has about 14 chapter in it, so
you may write down all of their names in a piece of paper & after reading each chapter you may give it a color,
either red, orange or green; the red color means that you felt difficulty while reading the chapter & you have
to understand it very well and read it again & again; it’s like a red flag that warns you that you have to master
this area before you take the test! The orange one is a 50-50 or you can say when you experience some
difficulties in the chapter (you may write these down) & the other facts were easy to swallow. The green color
is that the chapter is very easy & smooth on the memory that you may recall it & don’t have to repeat it every
now & then like you shall with the red colored for example; Go & YouTube “Spaced Repetition” & watch
Osmosis’ video about it, and you’ll get my idea. The red & orange colored chapters should be understood,
read again & again, until you turn these colors into green, so by that way, you mastered some weakness areas
before even doing an NBME; but you have to be honest with yourself & not give all of them green marks! :D
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The other tip I used is that when I read it for the 1 time I started in the same order of the book, starting with
biostatistics & behavioral sciences (Yuck!) & ending up with respiratory system; this first round took me
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around a month. From the 2 round & so forth (each one took me about 2 weeks or less), I did the book from
back to front (starting with the respiratory system), as starting from the biostat part may take time & you
might feel stressed out that you won’t be finishing the book this year! So changing order, & starting with the
late chapters or the ones that you accomplish rapidly, is important in such a big book to avoid boredom.
I used FA16, and in the last 2 weeks I looked over the FA17 draft .pdf file to know about the new facts that
have been added to the book; nearly, there was nothing new, as most of them were facts that I got tested on
in UW, but they’re laid out in an organized form, that’s all. I didn’t like the idea of annotating too much in the
book because that would distort the shape of the page & it would be annoying my photographic memory,
since all of the book is filled with tables, comparisons, algorithms & diagrams.

12) NBMEs
This is nearly the most important phase of your whole preparation, to know where you stand & whether
you’re ready or not. This is the self-assessment phase; these exams are written by the NBME (who also
write the questions of the real exam). So, most of the time, if you got a score in an NBME, you might get a
+ or -5 around the same score you’ve got (sometimes + or -10), if you took them online; offline NBMEs are
completely useless & there is no one that knows how they estimate the score & you don’t know where do
you stand compared with your peers who will take the test; So, if you have the time (& the money) you
may take them all online (with the option of the expanded feedback; as it gives you the opportunity to
know the questions you got wrong); start with the old ones available in the website i.e. NBME 13 &
gradually till you take NBME 18 & 19 just before your test. I’d recommend that you start doing that early
enough before your test (1.5 – 2 months before the exam); A friend of mine, who took Step 1 before me,
advised me to use NBMEs to strengthen my weakness points in the following manner: I’d take an NBME
e.g NBME 13, then look at the performance profile & check which discipline/system I got a low or
borderline performance in it, then I go back to my FA & improve these points again & again till they
become a strength in the next NBME; doing that may take up to 5 or 6 days after the NBME; then I take
another NBME & see; the previous weakness points now should have a better performance, but at the
same time, new weakness points will appear; I work again on them from FA & absorb them very well &
take another NBME… and so on till I finish the last one before the real deal with the minimal damage I can
afford. That way, you’ll be focusing your studying from FA on the points, that you know by heart that,
you’re weak in them & your concentration will be doubled, because you don’t want to have this kind of
performance when it really counts. I also took the UWSAs (Forms 1 & 2) which were similar to the UWorld
questions but in an exam-format. Listed below, are the NBMEs & UWSAs I took with the score & date; I
took all of them online (even the old ones); if you can’t take them all online, at least don’t miss NBME 18
& 19 as they’re the most recent & by far shall be the most predictive. The order was:
th
- NBME 13: 232 (5 January 2017; 1.5 months before)
th
- UWSA2: 245 (13 January 2017; 5 weeks before)
nd
- NBME 15: 234 (22 January 2017; 4 weeks before); I admit that I got a bit disappointed because I
expected a better improvement, not just 2 points from NBME 13!! But that wasn’t the end just yet.
 th
- NBME 16: 240 (7 February 2017; 12 days before)
th
- UWSA1: 251 (12 February 2017; 1 week before); I took after it the Free 120 questions (3 blocks)
provided by the USMLE Official Website & got 85% (102 right out of 120); I did that to simulate the
exam day & be able to keep my concentration for the whole 8 hours; try to do it at least once, but not
more than that to avoid mental exhaustion.
th
- NBME 17: 248 (14 February 2017; 5 days before)
th
- NBME 18: 248 (17 February 2017; 2 days before!)
th
- Real Deal: 251 (19 February 2017)

Between NBMEs 15 & 16, I took another, semi-final, round of FA.

I won’t talk about which ones were easy & which one were hard to avoid affecting your performance
when you take them; no one knows what the exam difficulty is really like except after taking it, so
consider yourself taking the real test multiple times before your real deal.
As you can see from the numbers above, NBMEs 17, 18 & UWSA1 were the most predictive for my case; I
didn’t take NBME 19, because it wasn’t available yet, & NBME 12 because it was very old from that point
(+5 years old).

13) Last 2 Months

It started to get more serious from that time; I spent most of the time reading FA & revising UW questions
I got wrong or the ones that had new facts; I revised them from the screenshots I saved using Snapper;
sometimes, I went back to KLNs in the topics I had difficulty with like immunology, biostatistics and ethics.
Started doing NBMEs 1.5 months before the exam.

14) Last Month

No rocket science here, almost the same as I did the month before that; I kept revising FA & stressing on
my weakness points & doing more NBMEs & UWSAs. In my final rounds of FA, I tried to understand every
word in it, didn’t flip the page until I search for the topic elsewhere & master it, either in YouTube
(especially Osmosis’ videos), UpToDate, Robbins & Cotran Pathology Atlas… etc. That’s why FA took me
about 2 more weeks between my NBMEs 15 & 16; finishing 50 pages from FA a day with understanding
every bit of a word is better thousand-times than finishing 100+ pages without even knowing what they’re
talking about!

15) Last Week

This was the time when I wanted to rest my eyes as much as I can, to save energy for the upcoming event;
at the same time, I tried to reset my biological clock so that my brain would be fully awake, in the same
time I shall take my exam (9 a.m. – 5 p.m.), and don’t need to take a noon nap. I watched some selected
DIT videos extensively in my weakness points until I almost mastered them (especially the micro&immuno
& some neuro). I also did most of UWorld tables & diagrams and revised my handwritten UWorld notes I
took before. I used to go to bed early, wake up early & try to have quick look on most of FA pages as a
final look/goodbye before the exam.

16) Last Day Before The Exam

I tried to relax as much as I can; didn’t do anything apart from reviewing NBMEs questions I got wrong &
the ones I had doubt about but I got them right & had a quick look at some FA pages, using only my eyes,
without trying to test myself or recalling anything; I prepared my scheduling permit, my passport, some
snacks for the breaks, Panadol Extra tablets, a bottle of water & had them in my back-bag, to avoid
preparing such stuff in the early morning. Went to bed at 9:00 p.m. & had about 6 hours of sleep.
N.B. Prometric will send a reminder to your e-mail 2 days before the test & your test center will call you
the day before the exam to confirm the appointment with you & tell you about the regulations &
restrictions & what time to show up on exam day.

17) Day of The Exam (From A to Z)

I woke up at 3:30 a.m., checked that everything in my bag is ok & that I didn’t forget any important stuff,
had a breakfast of macaroni mixed with small meatballs, then a cup of coffee (this was my first encounter
with caffeine, because I cut off taking it in any form a month before this very special day, to allow the
coffee to take its effect very efficiently). I wore comfortable clothes, sweatpants (to make myself at home
in the center) & had a jacket (it was Winter back then). I looked quickly at the equations section at the
end of FA before I got out (didn’t take the book with me). Got out of home at 6:30 a.m. & was at the
testing center at 7:30 a.m., entered the center at 8:00 a.m.; you will set in a reception & they’ll give you a
paper with the regulations & prohibitions of the exam day; you will be given time to read it & go to the
restroom until they call your name to enter the test room (I went to the restroom to get rid of the coffee’s
diuretic effect); after calling your name, they will give you a key to put your baggage in a small locker;
then, they will take your fingerprints, a photo of you (smile, because you’ll see that photo each time you
return from a break :D); you’ll be ordered to pull your sleeves up to the level of your elbows, your pants
above the level of your socks & turn your pockets inside out to make sure that they’re empty (so try to
wear something that has less or no pockets in it); you will then raise your hands horizontally, and they’ll
scan you with a metal detector from the front & back; important to note that these actions are done
every time you return from a break (so have in mind that they’ll take some of your break time). They’ll
give you 2 laminated papers (to take notes), a marker & an eraser; your name & CIN (the number needed
to unlock your exam) will be written on one of the laminated papers (don’t erase it, as you will use it each
time you return from a break). The only things that will be allowed to enter the test room with you are
your passport, your locker key & your personal earplugs (I didn’t have one; they also provide a noise
cancellation headphones); anything else should be kept in your locker.
You may watch this video to know more about the regulations & the test environment:
https://vimeo.com/190759122

To be honest, I was very obsessed about the idea of taking an 8-hour exam, because I’m that kind of
person who sits for an hour studying & then starts to fidget!! I kept overthinking about it a lot! But after I
simulated the test a week before, I had that feeling that I can solve more questions & that my
concentration will be more of course in the test room than sitting on a chair in my home; So gradually, the
8-hours thing won’t be an issue for you as long as you did your best in preparing for it. My exam was 7
blocks, each one has 40 questions (except the last one was 28 questions) with a total of 268 questions.
The exam started with a tutorial, I made sure that my headphones are working well & skipped the tutorial
to add its 15 minutes to my break time (the same tutorial is available on the USMLE Official Website, so
do it before your real deal). Exam interface was exactly the same as the free 120-question sample; layout
of the questions was like UWorld (about 5–7 lines) with some questions in one line but +10 choices, and
some were about 12 to 15 lines!! The difficulty of the questions was at the level of NBMEs or a bit higher.
My strategy in answering the questions was reading the last phrase (the question itself) to know what the
vignette is talking about & in what discipline they’re asking & then looking for the clues in the rest of the
vignette, trying to come up with an answer & then look at the choices & choosing the best answer that
fits; I gave any question I encountered a minute to come up with the answer; if it was difficult or I didn’t
remember the answer yet, I’d give it an extra 30 seconds; if still nothing new, I marked the question,
moved on & came back to it in the end if I had time; then after getting back to it, I might remember the
correct answer or not; in that case, I tried to eliminate wrong answers, make an educated guess & that’s it
(staring at the question won’t come up with anything new); always have in mind that a difficult question
maybe an experimental one, so that you won’t get nervous when you see such questions! Using this
strategy, I had about 15 to 20 minutes left to answer about 8 to 10 questions & some marked questions to
revise; practicing time management during your UWorld blocks will make it easier for you during exam
day. My exam had some difficult biochemistry & ethics questions, while the psychiatry, biostatistics,
immunology were direct & straight forward and the other disciplines were variable; I can’t remember
which discipline was asked the most in my exam, but it was a strange mix of “Is this a joke?! Where is the
question?!” type of questions, the very long question stem but with an easy answer, the difficult
questions and the ones I’ve never heard about (the other extreme of “Where is the question?!”). I took
my breaks in the following order:-
- First 2 Blocks (without a break in between) then a 5-minute break (without getting out of exam
room).
rd
- 3 Block then about 10-minute break; I ate 3 bananas & went to the rest room.
th
- 4 Block then a break where I took 2 Panadol Extra tablets (to avoid getting a headache).
th
- 5 Block then a small break; I ate some homemade French fires quickly.
th
- 6 Block then the final break; I drank some juice & ate a chocolate.
th
- 7 Block then I was FREE! :D
You won’t feel all of that time at all, it was like a pinprick! I remember the first time I looked at the clock,
when I got out of the room, it was 2:20 p.m. (exam started at 9 a.m.); at the end, I had unused 15 minutes
from my break.

18) Feeling After Finishing The Exam

Just celebrate; whatever you did in the exam, it’s over & now you’re relieved; I didn’t believe that I’m
done with the exam for a while! Later on, when I started to study IM for my school, I had that feeling that
I will get a 220!; that feeling kept escalating, each time I encounter a topic in IM because it reminded me
th
of questions I did wrong, till the result appeared on 8 March 2017 (2 weeks & 2 days after the exam).
After the exam, despite the celebration & that kind of feelings, I felt that I only remembered the difficult
questions & that my exam had no easy question in it, at all! I thought it was a natural feeling as the hard
questions you read them multiple times to come up with an answer, think a lot while reading them, mark
them… etc., while the easy ones you just choose an answer & never come back to them again; so what’s
left in your memory are the tough ones, cause you gave them most of the time & concentration. I heard a
saying before & I believe it’s true: “Anyone that gets out of the exam, and thinks he did well, is a complete
idiot!”.

19) Weakness Points

My weak areas were behavioral sciences (ethics & psychiatry), biostatistics, genetics, immunology, &
some microbiology (especially virology & mycology); that was back then when I first started doing NBMEs.
Later on & by time, they were narrowed down to the ethics part (it always gets me) & I had a lower
performance on behavioral sciences because of it and hence, a lower score. NBMEs helped me manage
these areas a lot, together with selected DIT videos & FA of course. But my true weakness point, and you
won’t believe me, was OVERTHINKING! You’ll get my idea when you compare UWorld questions with
NBMEs/real exam; the UWorld questions were not that straight forward, you know somehow that the
answer is not that simple & you have to do multiple steps to achieve an answer! While in NBMEs, the first
simplest answer that comes to your mind is the right choice. For example, I remember a question in an
NBME giving a presentation of an old man (in the 50s or 60s) with jaundice that was diagnosed later with
pancreatic cancer, and the question asked about “This patient is at increased risk of which of the
following?”;
The easy simple approach would be: an old man + cancer = “Major depression”, while the overthinking
one would be: his cancer will obstruct his common bile duct, so that his direct bilirubin would leak out
into his blood, and somehow enter his brain causing either “Memory impairment” or “Personality
changes”! I think you got my idea now. Another very crucial point to mention about overthinking is that
you’ll get a lot of easy silly questions wrong that way; making mistakes in these types of questions is fatal!
2 or 3 easy questions wrong-answered may get you a borderline, or even a low, performance in that
discipline; It’s just like an oral discussion with a doctor that starts with the easiest type of questions & you
don’t know the answer, he’ll get the impression that you have no idea what he is talking about!! The same
applies here; Don’t get these questions wrong please! These are like free points, so guarantee them. I was
getting 5+ (or even 10+) questions wrong in NBMEs because of overthinking; that’s why I’ve never passed
250s in my NBMEs; I tried to minimize that by time till I made 2 silly stupid mistakes in the real deal; I
could’ve had 255+ right now, but I’m satisfied with my score anyways. That’s why I’m telling you to do
NBMEs online, because the distribution of marks on questions is never equal & you don’t know how they
calculate the score.

20) The “DO”s

Things that I’d recommend you to do them:
- Start solving questions early; applying your foundation very early is the best active method of
memorizing instead of the boring passive reading (you may watch Osmosis’ video about “Testing
Effect” to get my point); badly for me I started a bit late, but it wasn’t too late, luckily.
- Start reading FA as early as possible; another mistake I did that I didn’t start it with my first read of
KLNs; I focused more on KLNs than FA (while the reverse should have happened).
- Try to study actively (as much as you can), and not passively, by making tables, comparisons, writing
notes in your own words, explaining to others or your SP, using flashcards… etc.
- Eat healthy food & practice any kind of sport you like to have a stress-free mind.
- When it’s late & you got tired & sleepy, admit it then; you’re tired, go get some sleep. Destroying
your brain that way won’t get you any advantage by any mean.
- Try to record hard mnemonics in FA by your own voice in a rhymed-manner, so that it would save
your time by just hearing yourself & using your senses in memorizing; I had that idea just about a
week before the exam, but I didn’t get to apply it; so you may do.
- Try to do NBMEs a bit earlier than what I did; I started them 1.5 months before my exam; I’d
recommend that you start doing them at least 2 months before, so that you have enough time to
master you weak areas & stress on them.
- Manage your time per block while you’re doing UWorld; time management in the real exam has to
come gradually & throughout time; and UWorld, in “timed” or “timed tutor” modes, provides you the
best opportunity to do that.

21) The “DON’T”s (AKA Don’t Repeat My Mistake)

These are bad mistakes I did that prolonged my preparation period & I want you to avoid:
- Don’t interrupt your studying; studying for USMLE must be comprehensive & consistent; interrupting
your study schedule or taking too many days off will make you late & your brain becomes leaky, to
 the point that you may start from the beginning again each time!! So, dedicate yourself as much as
you can.
- Don’t schedule your exam very early saying “I have a plenty of time & I’ll be ready”! You don’t know
what might happen in the future; you’ll end up postponing your test day every time & stressing out
yourself & losing your concentration. The best time in my opinion to start scheduling for the exam is
st
after finishing Online UWorld for the 1 time; depending on how fast you are, you may need 1.5
months to 2.5 months from finishing UWorld point; this period is for revising your FA, marked or new
UWorld questions & doing NBMEs. The paperwork takes about 3 weeks, so don’t ever worry about
that.
- Don’t start UWorld before you finish FA (at least once); doing so will exhaust your time & effort and
you won’t be able to filter what’s new in UWorld, and not present in FA; it would give you the feeling
that all what’s written in the bank is new! And you’ll end up wasting your time annotating it, while it’s
written in FA in a word or two!! It’s the same concept that applies to reading Dr.Goljan’s after
Pathoma.
- Don’t take the NBMEs scores for granted! What I mean is, getting the score you want in an NBME
doesn’t mean that you just show up on exam day & you’ll get a similar score; No! You’ll get hard
questions & you have to work your mind up during exam day, to the point that you won’t stop
concentrating & your brain will burn from thinking, until you get your desired score; So, don’t
overrate your self-confidence.

22) Pages You Need to Review From Dr.Goljan’s

I’ve included this section because I know that not all of you will have the time to read the book; so these
are the topics, that might be important for you to have a look at, provided with page number:
- Leukocyte alterations: from page 51
- Serum protein electrophoresis in inflammation: from page 54
- Mixed connective tissue disease (MCTD): from page 80
- Box 5-1 Volume Control: from page 99
- Aging: from page 156
- Chapter 7 Environmental Pathology: page 158
- Table 10-2 Vascular tumors and Tumor-Like Conditions: page 231
- Box 10-1 Hypertensive Retinopathy: page 238
- Malaria: from page 314
- Langerhans Cell Histiocytoses (Histiocystosis X) & Mast Cell Disorders: from page 343 to page 345
- Table 14-3 Additional Plasma Cell Dyscrasias: page 348
- Anorectal Disorders: from page 464
- Table 20-1 Types of Proteinuria: page 501
- Table 20-2 Causes of Increased and Decreased Serum BUN: page 502
- Serum BUN/creatinine (Cr) ration: from page 502
- Table 20-3 Causes of Increased and Decreased Creatinine Clearance (CCr): page 504
- Table 20-4 Urinalysis: from page 504
- Box 20-1 Differential Diagnosis of Oliguria: page 517
- Avascular (aseptic) necrosis (AVN): from page 634
- Osteochondritis dissecans (OCD): from page 635
- Table 24-3 Selected Orthopedic Disorders: pages 655 & 656
- Selected Skin Disorders: from page 680
 - Selected Skin Disorders in Newborns: from page 686
- Box 26-1 Cerebospinal Fluid (CSF) Analysis: page 694
- Table 26-2 Viral Infections of the Central Nervous System: page 709
- Table 26-5 Fungal and Parasitic Infections of the Central Nervous System: page 711
- Table 26-7 Selected Eye Disorders: pages 727 & 728
It would be better if you read these chapters from beginning to end:
- Chapter 7: Environmental Pathology
- Chapter 20: Kidney Disorders
- Chapter 25: Skin Disorders

23) Dr.Najeeb’s Lectures (& When to Watch Them)

Dr.Najeeb, in my opinion, is an amazing lecturer; he explains the hardest concepts from scratch, escalates
in the difficulty level gradually, without feeling that, until he reaches the peak of the topic with you. His
lectures however, contain a lot of low-yield material that are not important for USMLE Step 1 at all; but
they’re good for a better understanding. I watched his Neuroscience lectures after finishing the branch
from KLNs (recommended to me by my SP). They are 60 hours of pure gold; after speeding them up to
2.0x, you’ll finish them in 30 hours; which can be divided into 10 days (3 hours daily) & you won’t be
cramming at all. Otherwise, you may use his lectures, as a resource, in topics that you don’t understand
very well; it would be a great reference.

24) Summary
- Preparation period was cut down to half to be 12 months.
- Order of studying disciplines: histo & anatomy – physiology – biochemistry & genetics – micro &
immuno – pathology – pharmacology – behavioral sciences.
- I did pathology from Pathoma then Dr.Goljan’s.
- I did KLNs 2 times & Pathoma 3 times.
- You may start with multiple resources; but narrow them down to FA & UWorld only as you get closer.
- You may watch DIT videos in the times of boredom.
- If you studied dermatology without pictures, you’re wasting your time.
- Use YouTube as a good reference.
- Avoid burnout & practice sports.
- Try to have a study partner.
- Do what you love & what makes you happy during preparation, life is not all about studying; no one
studies the whole 24 hours.
- Q-banks are learning tools.
- I did UWorld 1.5 times & 2/3 of USMLE Rx; didn’t do Kaplan Q-bank.
- UWorld is the most important Q-bank
- Practice time management per block while doing UWorld
- FA is the baseline of knowledge that every Step taker must have; expand your knowledge from that
point.
- Understand every word in FA.
- Use NBMEs to strengthen your weak areas.
- Don’t do NBMEs offline; they’d be useless!
- Don’t overthink while doing an NBME (or in the exam); the first simplest answer that comes to your
mind is mostly the right one.
- Start doing NBMEs early (at least 2 months before exam)
- Stick to FA & UWorld till the end.
- Relax the day before the exam & get a good night sleep.
- Give an extra 30 seconds to each question you don’t know about; if you came up with nothing new,
make an educated guess & move on.
- This experience applies for me & my study partner; the only difference is that he didn’t do USMLE Rx,
instead he did Kaplan Q-bank. He took his exam before me (because I was slow in reading) & got 247,
and I got 251.
- There is no perfect experience after all, so stick to what works best for you

25) Acknowledgment
Finally I admit it; all what I did, I couldn’t have done even half of it without the support of my parents, my
SP, my friends & every other colleague who took the exam before and gave me his valuable advice.
Thanks to everyone who have been there for me & helped me during that period of time; I couldn’t have
do it without you, honest. I won’t mention names because I’m sure that I’ll forget some, but I’ll tell them
that they’re mentioned.
Thank you.

26) Final Word(s)

Believe me, those who did it, are not special and, are no better than you by any mean; they’re just hard
workers. The USMLE pathway is all about the 3Ps: Persistence, Patience & Passion; it’s not an easy one,
but it’s not impossible either. Always remember that, the only barrier between reading an experience &
writing one is honesty with yourself, a simple but hard dedication, and trusting your abilities that you can
do it. And remember that “One day… “ always starts with “Day one”. Stay motivated throughout your
journey, and consider yourself “MATCHED” from the very first day of your preparation. It’s natural to ask
for help when you need it, whether it’s a family member, a friend or anyone; always have support from
those who love & care about you.

Bless you all and your hard work & may you find what you’re seeking... one day.

Sincerely,
Ahmed.