Saturday, June 4, 2016

Step 1 score 256 experience by Satish Advani

So in this post, Satish Advani, CMC Pakistan talks about how he scored a 256 on Step 1 and his journey.

I’ll try to make this guide as helpful as possible. Whatever I write here is based on my own experience and the experiences of top scorers I observed during my preparation. 

This is the most important part of your preparation and probably most variable also because it depends on your previous knowledge and your way of studying so you have to find out what works for you.

Kaplan, highyield, roadmap, BRS, etc etc the list goes on and on. Important thing is to stick with one book for one subject. If you have difficulty understanding anything google it. It will take sometime but it is going to be worth it.

Here is the list of stuff I used, whether or not I found them helpful and what was my previous knowledge in these subjects (on a scale of 0 to 10)

Physiology: 4/10
I never read Guyton or Ganong in my medical school. Just glanced at a review book to but still I never found this subject too hard.
Kaplan notes - Read the notes and watched the videos . I didn’t like this book. Dragged myself upto the renal system then decided to skip. And then started BRS.
BRS physiology - Hands down the best book for physiology. Probably somewhat difficult to understand at first because its written in a concise way but it’s GOLD my friends. It's questions are important also specially the CVS and respiratory part. Owe my star to this book for these systems.

Anatomy: 3/10
This was my most dreaded dreaded subject. Reason #1 because I had a very weak background knowledge. No wonder I failed in this subject in my first year of med school. Never read a single word of neuroanatomy . Reason #2 recent exam change had focused on including more questions from anatomy.
Kaplan - Read the notes including the neuroanatomy but skipped the videos. 
BRS gross anatomy - Skimmed through the clinical corelations, muscles chart and pelvic anatomy etc
High yield neuroanatomy - Decided to use this as well because at that time this book had too much fame and I had weak knowledge about this subject . I realize now this was a mistake because I never got time again to revise this one.
Anatomy Shelf notes - A good resource but only use it if you have got extra time. I never finished it. You can not read this without first knowing the basics written in Kaplan or any other review book.

Biochemistry (including genetics and molecular bio): 4/10
Begin your study with this subject because this can turn out to be a solid base for other subjects like pharm. I had done well in this subject (nutrition and metabolism) in my medical school but never studied genetics or molecular biology. Again! not even a single word!
1. Kaplan notes - Read along with the videos. This is the only subject where Kaplan is at its best. You don’t need anything else for this.

Pathology: 5/10
I never studied big robbins in my medical school or anything. Totally depended on review books and I somehow did pretty well on this one always.
Goljan - I studied 3rd edition in the very beginning of my prep.. like 7 months or even more before the exam and I had forgotten everything in these 6 months and I never got time to revise this one so I don’t really think I would call it as my resource for this subject. but it is amazing book. Very important to do if you have time.
Pathoma – I watched the videos only. It is a really great resource. Especially the way histopathology is explained. It cant get any better than this.

Biostat and Epidemiology: 0/10
This was like alien language . I never read anything about community medicine in my medical school. By this time, you might be wondering how the hell I made it through the medical school :D but keep reading and you’ll wonder more. 
Kaplan notes - okayyyy this was a good one. Read the notes and watched the videos. Found it helpful but still I wasn’t ready for this one. 
BRS - just about a month before my exam I borrowed this book from a friend and I got to say this is a great book I did only the biostat and epidem portions and it was great. The questions are gold . now I was feeling pretty good about this one .
UW biostat and epidem review - if BRS was gold then this was Diamond. After this I felt ready to take down these questions.

Microbiology: 3/10
I had never studied anything about virology and fungi . I only did bacteriology and parasitology in my medical school and passed the exams. So I had to work a bit extra for this one also.
1-Kaplan notes- did them with the videos. And OMG! what a load of horse shit this book was. LoL!!!! And the lady in the videos was so slow . after every sentence she takes a big deep breath like she is goin to faint or sth. It made me feel so sleepy . this was total bullshit . only the parasitology stuff is good. 

Immunology: 1/10
Again… not even a single word ever! So extra work was required.
Kaplan notes - Did them with the videos. The notes are very good. The videos are absolute waste of time.

BURN OUT! At this point I looked back and I realized I don’t remember anything at all. I had wasted too much of my time on these big Kaplan books. And I still had Pharm and behavioural science left. So I decided to review some subjects and start First Aid asap. And you guys will feel this way as well and its normal because we all are human after all, not machines.

So instead of going any further, I thought to revise what I had studies so far. I reviewed phyiology from BRS with kaplans 700 Qbank. Reviewed biochem, genetics, mol bio,  biostat and imuuno. The rest of the subjects I didn’t review.

Pharmacology: 2/10
I didn’t even know how aspirin works :/
FA + only the basic stuff and ANS chapters from Kaplan - This subject is all about cramming and a little bit about understanding stuff like the bioavailability, solubility, agonists. antagonists etc etc. you can skip Kaplan on this one. I heard the videos are good and I did try watching some of the lectures by Dr. Raymond and I enjoyed him being obsessed with ‘butt’ jokes but then I realized this was taking lot of time so I stopped and focused on FA and UW only. 

Behavioural science: 0/10
This was again alien language but I did know stuff like mania and depression probably because of personal experience of suffering this during my prep :P
Kaplan notes except the DSM IV - Good resource. Did the notes really quickly with the videos. For DSM IV/V I did FA only. 
BRS - I glanced through this one on some topics like health care system in US the pay and the insurance stuff etc 
Ethics book by C. Fischer

Miscellaneous stuff: These have their importance but are very vast so I’m going to try to be specific here.

Webpath- amazing source but I couldn’t finish it.  Not too important. 

Google images - This is pretty random but very important. Any buzz word you see google it e.g pick bodies, clouded cornea, soap bubble appearance, birefrigent crystals , saber shin ,coffin lid stone etc etc you won't get these buzz words. You get the description of these things in a weird way or a picture of it so think outside the box here.

Wikipedia - This is again random and huge but this is important for topics that you don’t understand or stuff that’s ignored by review books like Kaplan (Check step 1 content outline and you will have the idea of what I’m talking bout here)

And FINALLY now it was time to bring the big guns 8|

uWorld and FA.

FA - The first read took me about 3 weeks. I also made some notes from Kaplan on FA which was totally worthless. After my first read of FA, I started uWorld. 

uWorld - This is like bazooka. This is the best thing to prepare from. I did this with FA, annotating along the way. If I didn’t understand anything I would google it and find out the explanation. This is important. I didn’t go through books as much as I did through the Wikipedia, Medscape and any thing on internet I could get my hands on. And you know what? I had questions on exam that are not written in these review books. So thank you Wikipedia. I never looked back on Kaplan or any other book. FA + UW was the my focus now.
But Before going for UW, I took nbme 7 and I didn’t do well. 

After UW, I did NBME 3 and was able to get a good score but it didn’t matter since this form was way too old. So I reviewed FA again quickly and started UW 2nd time. This time I tried something different and crazy I would say. I would do at least 7 blocks continuously and timed mode on one day and review it on next day. Sometimes I would do as many blocks as I can, back to back everyday. This way I finished UW 2nd run in 10 days.

BURN OUT: Seems like doing UW in this crazy way wasn’t such a  good idea :/ I was very very tired. I took NBME 11 and got a very decent score. I was happy but I knew that 11 is also old form and the exam is not going to be so easy.

After all this I didn’t have any energy to do FA anymore and that’s when I started DIT. I used DIT as a study companion. Like a study partner. It kept me focused and I finished it with reviewing FA, with all the annotations and notes I made.

It was time to assess myself again and I took NBME 13 and my score dropped from 11 by 7 points. I wasn’t happy obviously. I was stressed but I couldn’t go on any further. Took rest for few days, got my courage back from watching avengers new movie :p and I decided to sum it all up for one last time. I did UW 3rd time only for practice. I didn’t read explanations this time. It wasn’t really helpful now but anyway I finished it in few days along with FA. Did NBME 15 and score dropped again. I seriously started doubting myself now I couldn’t understand what was wrong. May be I was just tired or may be I wasn’t focusing while reading question. I found 15 to be somewhat difficult in understanding the way its questions were phrased. Anyway, I had a 2 weeks left for my exam now and I didn’t want to postpone I reviewed FA along with Kaplan qbank for some subjects. I  took 16 and score jumped a little but still it wasn’t where I thought I was. 

Last 4 days before exam, I didn’t study anything. It was Diwali and I was just relaxing and making myself ready for the exam mentally. One day before the exam, I reviewed biochem pathways and biostats and all the formulas. 

Monster was here and the big guns were ready. in the very first block I faced some weird CK type questions and I thought to myself well may be the weird block is over and now the rest of the exam would be somewhat a smooth ride. But I was wrong. In every block, I had CK type questions and the wtf anatomy questions that were out of Kaplan, out of uWorld and out of any world. Who gives you weird MRIs of limb and asks to identify the muscles? This was unfair. I was like WTF is happening here. I calmed down myself and I tried to do as best as I could. The questions were very long with ton of labs and pictures. I could only spare myself 5 minutes to review the questions I had marked which ranged from 12 to 20 in every block. I couldn’t review all of my marked questions in 5 minutes. 

In the retrospect if I had known I would face this kind of exam 
#1 I would not have spent my time on any Kaplan book except its biochemistry. 
#2 I would have done all of webpath 
#3 I would have saved time to do goljan
#4 I’d have solved more questions
#5 I’d have seen more pictures including gross pathology, dermatology, CT scans and MRI of muscles

A friendly advice to average students like me
Know that the journey is long and nobody has smooth sail. you will make mistakes. you will make sacrifices . you will face challenges. people may doubt you but never doubt yourself. Keep their criticism in the head not in the heart. Sublimate those emotions and focus on your journey.

For my sindhi friends ‘edo na thi jazbati chaati na pawaee phaati’ :D

Take it easy people and good luck!

That's all!

Thank you, Satish, for allowing me to share your experience with my readers :)



  1. hello satish !

    Congratulations on your high score, this was a great overview of all you did. My only query was as to how much did all this stuff like uWorld and all cost ?

    1. You can check the uWorld website for Qbank costs.

  2. how long did it take to prepare for the Step 1


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