Tuesday, March 13, 2018

My USMLE Step 1 Experience ( Road to 255 )


Hello everyone :) I would like to share with you what I did/studied for USMLE Step 1
It is gonna be long because I tried to include every single question that I was asked about my prep

First of all, I would like to thank everyone who I met during this journey from all over the world, Thank you everyone!

 Sources used for studying:

>First Aid
>First aid proposed and official errata (please check the proposed errata before studying any page in First Aid, it may have nice mnemonics, corrections. concepts..etc):
*https://www2.usmle-rx.com/proposed-errata-and-suggestions-fa-step-1
*https://firstaidteam.com/updates-and-corrections/
>Uworld
>Uworld biostat review
> +/- kaplan epidemiology part for step 2 ( those 2 youtube videos may be used in addition to  kaplan):
https://www.youtube.com/watch?v=75pQPB1RF50
https://www.youtube.com/watch?v=VMI9UuNqoGI
>Pathoma
>a person rearranged Pathoma into this amazing Onenote website:
https://onedrive.live.com/view.aspx?cid=375c2c99998a5c62&page=view&resid=375C2C99998A5C62!2705&parId=375C2C99998A5C62!2703&authkey=!AHH10BbZMBrqM0k&app=OneNote
>Sketchy micro and pharm videos ( I didn’t watch all videos but a lot them are really helpful)
>Kaplan videos for biochem / Sam Turco
>Kaplan step 2 patient safety chapter
>Conrad fischer 100 ethics cases
>+/- Flashcards notes ( Brosencephalon Anki deck for revision for some First Aid chapters)
>+/- BRS physio (curves and their questions in cardiology/respiratory)

 Method of studying:

>Did First aid general principles part except biochem 
Did some systems then went back to biochem
Then completed the systems

 >Uworld mainly done after first solid read of First Aid ( I started doing Uworld after finishing some of First Aid then I stopped and continued studying First Aid)

 >I didn’t do any online NBME but I solved NBME 15 16 17 18  and biostat and genetics questions in older NBMEs
Also did UWSA 1, 2 and FRED
(I felt my level was ok, I don’t advice you to do this..do 2 online NBMEs at least. I also didn’t try to convert my offline score and compare it..again, don’t do what I did :D)
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 First Aid and Uworld are used for all the subjects in addition to what is mentioned below:

  •  Biochem:

>Kaplan Biochem Videos by Dr. Sam Turco 
>Kaplan biochem book for pages that correspond to the videos only..fast skimming, don’t spend much time doing it!

  •  Immuno:

>https://www.youtube.com/watch?v=T_4TrNRa3v8
>https://mynotes4usmle.tumblr.com/post/74125122501/anticancer-drugs-no-bms-mnemonic#.WnqBQZx97IU
>https://mynotes4usmle.tumblr.com/post/95332165430/immunosupressants-drug-mnemonic-bc-everythings#.WnqB-Zx97IU

  •  Micro:

>Sketchymicro videos +/- pdf file of videos helps to cement info
>Use a lot of mnemonics whether from the proposed errata or any other source you find, also take care of the pics of organisms because they can be a question too.
> viruses DNA vs RNA and taxonomy mnemonic:
https://www.youtube.com/watch?v=Df_qAFF58Ec&t=1s
The video is drawn in a nicer way here too:
https://www.youtube.com/watch?v=rgz_3Yjw0vY

  • General Patho:

Pathoma
  • General Pharm:

Dr Raymond in Kaplan pharm about energy and inhibitors

  •  Public Health Sciences:

>Biostat: the more questions you solve the better, as mentioned above: uw biostat review
>+/-Kaplan step 2 epidemiology may help in giving a broader idea for a person who is studying biostat for the 1st time 
>Conrad 100 ethics cases + behavioral:Kaplan step 2 patient safety chapter

  •  Cardiology:

-Embryology:
https://www.youtube.com/watch?v=YxPp67XluQA&t=6s

 -Physiology:
BRS Physio - Cardio chapter ( if needed)

 -Pathology:
Pathoma
-Pharmacology:
Some mnemonics that may help in hyperdyslipidemia:
> https://www.youtube.com/watch?v=fTA5HOa87pM
> https://www.youtube.com/watch?v=HOXSaGpiSuo&t=3s
>http://www.medicowesome.com/2013/08/how-to-remember-lipoprotein-disorders.html

 Antiarrythmics:
> http://www.medicowesome.com/2014/10/antiarrhythmic-drug-classes-mnemonic.html
>http://usmle1mikmonics.tumblr.com/post/81324508295/bacman-class-1-antiarrhythmic-na-blockers

  •  Endocrine:

-Physiology:
+/-BRS Physio 
-Pathology
Pathoma
-Pharmacology
Sketchypharm..some really nice videos for anti-Diabetic drugs

  •  GI:

Pathology:
Pathoma

  •  Hemonc:

>Pathology and a lot of physio:
Pathoma
>Pharmacology:
In addition to many mnemonics that are found online, you may check the anti-Neoplastic part of Sketchy pharm, I haven’t seen it but I heard it is cool.

  • Musculoskeletal:

Pathology:
Pathoma

  • Neuro:

Anatomy:
>Some books in First Aid are not clear enough ..eg: the foramina of the skull,,I suggest looking for some pics that are not clear in First Aid.

 > A much simpler way to understand Basal Ganglia:
https://www.youtube.com/watch?v=-5PXAUdWDgU
(the whole channel: “Draw it to know it” is amazing)
>An amazing video to memorize the Brachial plexus:
https://www.youtube.com/watch?v=gTas7ijp0YE&t=328s
>Sleeping associated neurotransmitters
https://mynotes4usmle.tumblr.com/post/74247543467/neurotransmitters-associated-with-sleep-mnemonic

Pathology:
Pathoma presents tumors in a simpler way

  • Psych:
I suggest studying drug toxicities, DSM rules and drugs mech of action from Uworld because it is more arranged and accurate than First Aid.

  • Renal:

Patho and some physio:
Pathoma is great in pathology here and some parts of physiology are covered too

  • Reproductive:

>Physio:
Mnemonic for tanner staging:
https://mynotes4usmle.tumblr.com/post/152650094930/tanner-stages-of-development-mnemonics
>Patho:
The tumors part can be rearranged better in First Aid, I suggest focusing on Pathoma and checking the reproductive part here too, tables can really make things easier:
https://onedrive.live.com/view.aspx?cid=375c2c99998a5c62&page=view&resid=375C2C99998A5C62!2705&parId=375C2C99998A5C62!2703&authkey=!AHH10BbZMBrqM0k&app=OneNote

  • Respiratory:

>Embryology:
http://epomedicine.com/medical-students/lung-development-embryology-made-easy/
>Physio:
+/- curves from BRS physio
>Pathology:
Pathoma

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==============================================

 General advices/Before Exam:

-Mnemonics:
Mnemonics (memory aids) are a very vital part of step 1 ( at least for me :D ) that make remembering stuff much easier. A lot of the data is very dry but it stuck to your mind with mnemonics especially with pictures. I suggest checking the mnemonics in First Aid itself, First Aid proposed errata and these two very awesome websites:
http://www.medicowesome.com 
(for sure :D you ll find mnemonics for everything here)
https://mynotes4usmle.tumblr.com

 -Concepts:
Although memorizing is very important for step1, be sure to understand the concept before memorizing it. This is especially true in physiology because one fact may be asked in many ways.

 -How much time needed?
I have seen ppl doing it in a period as short as 5 months ( esp if step2 is done before) up to more than 1 year with others. In my case, It was on and off but if you want to put a timeline I would say 6-7 months.

 -How many times do I have to do First Aid? 
No fixed answer to this question. It depends on your type of studying. Are you the type who likes to read fast then revise again and again? Or you like one solid 1st time then a fast revision?
I personally prefer a very solid 1st studying time with mnemonics and concepts and a fast revision after that. In my case, I studied First Aid once and skimmed it once

 -Active studying
After you study First Aid and solve Uworld, try asking First Aid facts in a question form, do that on Facebook groups,Whatsapp..or with your study partner. Asking facts in question form will let you see many lines in First Aid that your eyes can oversee!

 -Every single line can be a question
Please don’t omit any line, diagram..curve in First Aid, anything can be asked! 

 -Arrangement
It is not necessary to study the subjects in a system exactly like First Aid
The 2 that are very connected are physiology and pathology. I sometimes used to finish Anatomy, Embryology and Pharmacology then go back to physiology and pathology.

 -Taking notes
This really differs for every person, some ppl like to write notes on extra notebooks, others write on First Aid or add sticky notes to it.
I starting adding notes from Uworld to First Aid then I stopped and continued taking notes using the flashcard program/app: Anki
It lets you search, add pics, audio and video 
Always remember the best notes are those you make yourself.
(Taking notes may take a lot of time sometimes so it’s ok too if you use other ppl notes)

 -Revision
You can come up with any personalized revision schedule you like, for me, revision was done after I finish the whole chapter in addition to its Uworld questions in the form of questions and answers with my friends on Facebook/Whatsapp.
Some already made Anki decks are there for step1, the most famous one is the Bronsenchephalon deck.

 -What if I need more?
I suggest making Google images and Youtube videos your new friend, they can simplify a lot of concepts. I didn’t use DIT videos so I can’t comment on them. Idea is when you need extra clarification go to youtube or google and don't feel obliged to watch video series like DIT or Kaplan..etc
I believe that watching Dr. Najeeb’s videos or studying Goljan or textbooks..etc is NOT needed and is beyond the scope of Step1 and will just take extra time from you with no much difference in score!

 -Uworld..how many times?
Regardless of how many times you ll do it, the 1st time should be always so solid, understanding concepts, writing notes..etc
Because when you solve Uworld again, recall bias would kick in and you ll be able to answer some questions not because you understand them but because you remember the question.

 -Uworld timed or not?
Many factors affect this, but if it is your first time with the USMLEs, you can do some blocks untimed in tutor mode then try timed mode, if you feel there is no problem with time, you can continue doing tutor mode.
Another method done by some ppl is to do Uworld tutor mode first read then timed mode in their 2nd read.
This is also affected by how fast you read English, how you train your eyes to omit distractors and by resisting the urge to re-reading the question sometimes. 
With time, this becomes easier!

 -Uworld system-wise, Subject-wise or mixed?
It depends on each person and each has his own approach.
 I think the 1st time should be done system wise excluding anatomy, microbiology, biostat. Biochem and genetics 
Eg: Cardio => physio, patholo, pathophsyio, pharm...same for other systems
Anatomy should be done all together, same for biochem, genetics, biostat, micro
This will help integrating the relevant data together.
Mixed mode can be done for marked questions or the 2nd read of Uworld ( depending on how many times you ll do Uworld)

-How to approach questions?
Always read the last line first...sometimes you may be asked a pharmacology question that is 10 lines long, then the question may be: the drug works by the following mechanism! This will greatly help in saving time for more questions in the exam.
After reading the last line, you can start reading the question from the start, a good thing is to highlight the abnormalities or the main points so your eyes can pinpoint what the question is asking.

 -Kaplan Videos and qbank
This questions depends on your level. I did my step 1 after graduation and I did CK before that, so in my case, I felt I didn’t need videos to explain the basics for me.
>I felt kaplan videos were needed for biochem, because in First Aid biochem is not that clear.
My advice is to watch the videos by Dr. Sam Turco, then look at Kaplan Biochem book to read what he explained but don’t see other pages that he doesn’t talk about because they are low yield.
>Kaplan pharmacology vid by Dr. Raymond may be used to explain the general pharmacology part of inhibitors.
>Kaplan qbank: in my opinion, it is not needed but it may be used for more practice for genetics and biostats questions.

 -Ethics!
Even after studying First Aid, Uworld, Conrad Fischer 100 ethics cases, you may find some questions in the exam in which you are left with 2 answers to choose from. Follow your guts and move on :D

 -NBMEs
>My advice is doing NBMEs starting from NBME 15 ...till 19
At least do 2 NBMEs online to get used to the exam preferably NBME 18 and 19
In my opinion. Older NBMEs don't represent exam trend and may have some very strange questions..but if you have time, do the biostat, genetic bands questions to be more used to deal with those. If you really have more time and you want to do all of NBMEs, you can do them too but know the concepts.
>Take NBMEs as an average, mostly your score will be somewhere between your lowest and highest score, It is something good to see you score increasing in each NBME, but put in mind that mostly NBME17 is underpredictive and that online ones are graded differently than offline ones. 
>If you get scores in NBMEs that are near the passing score postpone your exam till you get a satisfactory result! Step 1 score will haunt you all the way :D so give it your best shot :D

 - Step 2 and Step 1
I did CK before Step 1 so it helped in Pathology, micro, ethics, biostat, behavioral and a lot of pharm. In short, any step that you do before will help in the next one which leads to shorter studying time.


Exam day:

 -Sleep well..arrive early,,skip the tutorial  

 -Breaks during exam?
>If you skip the 15-min tutorial at the start of the exam, you ll have an hour of break time
>I took a break after each block with a larger break after my 3rd block, relaxing more, eating a bit more.
>Eat a bit in breaks, go to the restroom and try to relax your mind,
>Wear something that has less pockets to save time because you will be checked each time you enter the exam room after any break.
>Do a simulation test for yourself before the exam, spend 8 hours with breaks in between and know when you feel more tired or more hungry and decide how to divide breaks in the actual exam accordingly.

 -WTF questions
No matter how much you study, be prepared to find some strange questions in the exam, don’t panic, just follow your common sense, choose an answer and go on.

After the exam:

 >You ll feel some relief, you did a great job...8 hours are gone and It’s time to breaaathe and maybe eat a large meal :D 
>Now your mind will start remembering every single stupid mistake you did and you ll feel like: Who did I do that????
>Now 2 things: either leave it and suppress your ideas and hide anything related to Step 1 or go and do a brainstorming session and remember everything to reach a level of internal peace with what you did.
>You ll have some waves of anxiety for score anticipation in the 3 weeks after your exam :D this is NORMAL :)

Good luck everyone!

Written by: Murad 

2 comments:

  1. Congratulations, sir .255 is an insane score and I can only imagine the kind of hard work you have out in to achieve this. We would all like to hear about your future endeavours and plans .please keep writing at medicowesome .:)

    ReplyDelete
    Replies
    1. Thank you for your nice words :)
      Sure more posts are coming :)

      Delete

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