USMLE Step 1 Experiences IMG: High Score 276

USMLE Step 1 Experience: Score …..276
IMG – POLLUX – USMLE Step 1 Experience: 276Initial goal: 250+
Total prep time: 1000 hours.

IMG at an Australian medical school (UQ); MCAT=38
NBME 1: 258 (9 months out)
NBME 2: 261 (2 months out)
NBME 6: 262 (25 days out)
UW 1: 265+ (15 days out)
NBME 3: 265+ (8 days out)
NBME 4: 265+ (6 days out)
UW 2: 265+ (4 days out)
NBME 5: 265+ (2 days out)
USMLE CD: 96% (1 day out)

I did over 10000 USMLE-style practice exam questions in the following order:
USMLERx: 94%
Kaplan Qbank: 91%
First Aid Q&A step 1: 93%
UW: 88% (Random, unused, first time through)
Plus NBME + UW exams + USMLE CD + RR Goljan…

Prep material:
FA of course!! I read it cover-to-cover 3 times. However, I tend to cross-reference it when I read other books and I frequently consulted it during second year during PBL. I also annotated notes in FA when I did UW, so I was very familar with the content of this book. For every diagram/table/metabolic pathway in FA, I made sure that they were familiar to the point that I was able to to reproduce them from memory.
Anatomy: Kaplan notes & Kaplan webprep, USMLE Road Map Anatomy, HY Neuroanatomy.
Behavioural science: Kaplan notes & Kaplan webprep.
Biochemistry: Kaplan notes & Kaplan webprep.
Cell biology: HY Cell and molecular biology.
Microbiology: Kaplan notes & Kaplan webprep, Micro Made Ridiculously Simple, MicroCards.
Immunology: Kaplan notes & FA.
Pharmacology: Kaplan notes & Kaplan webprep, HY Pharm, Pharmacology Flash Cards (Brenner).
Physiology: Kaplan notes, BRS Physiology.
Pathology: BRS Pathology, Goljan audio, Goljan notes.

Preparation timeline:
Probably quite atypical compared to most US medical students. I initially intended to sit the exam at the beginning of third year, so I spent a month studying after second year was over. At the end of the month, I didn’t feel quite ready and decided to postpone my exam till the end of third year, thinking that I would have plenty of time to study during the clinical rotations. Wrong. I only had some time during my rural rotation and psychiatry rotation to study for USMLE, but could only manage to do 1-2hr/day on weekdays and up to 8hr/day on weekends. At the end of third year, I spent a month studying hardcore again, and finally took the exam on the 26th of December. The Australian school year runs from January to November, by the way.

During second year – Read BRS Pathology and pretty much memorized the book. I love pathology so it wasn’t really a daunting task for me. I also started listening to Goljan audios in first year and I was really glad that I started early. I finished Goljan audios at least three times, but I always felt that I learned something new each time.

December – Finished reading Kaplan notes (all subjects except Path) and Goljan notes for Path. 8-10hr/day. (300hr)

Jan – Nov – On and off. I did NBME1 in March and got 258(720) and was pretty happy that reading Kaplan notes paid off. However, I had only about 4 months during this time (rural and psych) where I could fit USMLE studying into my schedule, but could only manage to study about 25 hours a week. During this time, I read the supplementary material (HY, Road Map, flash cards), listened to Kaplan webprep while commuting, and did the majority of the practice questions. (400hr)

December – Did most of the NBMEs and UW assessment exams in this month. Completed UW question bank for the second time. Spent the last week just memorizing FA and doing practice questions. 8-10hr/day. (300hr)

Exam on December 26:

I started the exam at 8:30 and finished at 4:00 with 20 minutes of break time to spare. On average, I spent 45 minutes in each block and took a 20-minute break after each block (except the first block). During each break, I would drink 300mL of oolong tea or green tea to keep me awake, eat half a sandwich, go to the washroom, and wash my face so I felt refreshed and ready to tackle the next block. I thought the strategy worked quite well for me.

I thought the exam was quite a bit harder than NBME but easier than UW. It was probably comparable to UW self-assessment exams in terms of difficulty. I marked 6-7 questions each block. I thought 85% of the questions was straight-forward, 10% was tricky, and 5% was difficult.

Pathology: Not surprisingly the bulk of the exam. Around 70% of the questions were patholgy questions or required pathology integration. I thought UW covered these sorts of questions really well, so there weren’t really any surprises for me. I only had around 5 questions that came with pictures of gross pathology specimens.

Anatomy/neuroanatomy: 15 questions. Most of them involved intepretation of X-rays/CT/MRIs, nothing too obscure. I even had brain CT and angiograms for structure identification. Make sure you know the brain stem and cranial nerves well.

Behavioral science: 20 questions. Half were biostatistics, and the other half were the typical “what would be the best action/response in this scenario” type of questions. I thought just reading FA or Kaplan notes was not really sufficient to answer these sorts of questions. I had almost no questions that came out of the psychiatry section in FA, except a few psychotropic medications and a question on defense mechanisms.

Biochemistry/Cell bio/Molecular bio: Geez, I noticed the trend of increasing proportions of cell biology questions in the NBME, but I never expected this many on my exam. I probably had 50 questions that fell into this category (Biochem/Cell bio). I was glad that I flipped through HY Cell and Molecular biology just a few days before the exam, because it probably helped me answer 5 questions correctly. The different kinds of receptors and intracellular signalling pathways are extremely high-yield. For metabolism, know the key regulatory enzymes and global control of metabolic processes (i.e. insulin vs glucagon’s effects).

Pharmacology: Around 25 questions. Piece of cake compared to UW. I thought FA covers pharmacology in sufficient details. As usual, emphasis was placed on autonomic pharmacology and cardiovascular medications. I had quite a few questions on pharmacodynamics too.

Microbiology: 30 questions. Make sure you know the various bacterial exotoxins and their mechanisms of action. Quite a few questions involved TB and HIV. Even West Nile virus appeared on my exam.

Physiology: 30 questions. Most involved the up/down arrows and graph interpretation. Endocrine questions are high-yield too.

I walked out of the testing centre feeling quite confident I did pretty well. I was certain I broke 260, but wasn’t too sure if I was able to get 270+. Got the score today, 276/99! I didn’t even know it was possible! Needless to say, I was ecstatic!!
good luck….

Pollux
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