Step 1 Preparation and Experience USMLE Preparation and Experience

DON’T MAKE MY MISTAKE – Advice for Step 1 Candidates from Dr. Mahmoud Yousif

Exam score: 243


UWSA 1 & 2: 253, 262. 5 months before exam date
NBME 17: 255 4 months before exam date
NBME 16: 261 3 months before exam date
NBME 18: 271 3 months before exam date
NBME 11, 13 & 15 offline: 1 mistake,5 mistakes & 2 mistakes (about 274,268& 272) 1 month before exam date
Free 120: 95% 2 weeks before the exam date
UW first run: 68%
UW 3rd run: 95%

The Experience

FIRST OF ALL: don’t panic. I’m not writing my experience to freak you out saying that assessments are not predictable. because they are. I’m writing this to tell you that assessments are predictable UNLESS SOMETHING CATASTROPHIC HAPPENS, so don’t let it happen.



😑 10 days before my exam I had severe bacterial tonsillitis. I was looking at my throat in the mirror seeing pus everywhere.

🙂 5 days later I felt better

😪 next day had a common cold which was worse. I barely could get off my bed.

😩1 days before the exam I felt a little better but couldn’t sleep anyway due to continuous sneezing, body ache & headache

In the exam: the first block started, the guy next to me was very sick and kept coughing, I was like ” come on, seriously?” But I didn’t report him as he was working really hard to hold his cough not to distract us so I didn’t want to overstress him, but he couldn’t, this distracted me a lot, ear plugs didn’t work, my fingers didn’t work, in the middle of 9 to 10 lines question he coughs so I lose my concentration so I go back to reread the question, this happened all the way along the first block then I was shocked when I found out that I had only 5 minutes with 13 questions left I was like come on 😔😔😔this has never happened to me, I was always left with 10-15 minutes whether, in UW or other assessments. I managed to solve 3 only (as coughing stills there 😫😫😫😫), 30 seconds left, 10 questions to go, you can guess what I did, c next, b next, a next, d next, so on till the end without even reading the last line question.


I checked out, took 35 minutes break after the 1st block 😲😲😲😲😲, just trying to realize that this was real, is this really happening?? the first 20 minutes I was thinking of going home, I was telling myself, “An attempt is very bad, but a low score is much worse,” so I have two terrible options and I have to choose one. I was telling myself, “You messed the last 10 questions in the first block, even the first 30 you didn’t do good, you lost your concentration, you lost your confidence, go home.” Took my stuff, started walking, then I said, “Wait a minute, if you go home now you will not be able to look in the mirror again, you will not be only a loser, but you will be a coward loser, can you live with this??? go back, you can handle being a loser but you can’t handle being a coward, you studied hard, you did your best, but bad things do happen, don’t give up, don’t let it go,”

In the last 10 minutes I kept telling myself, “You can do it, you can do it, you can do it.”

Ok, let’s do it… I checked in, started the second block with complete loss of confidence and my heart was going like crazy, I was paranoid, I made idiotic mistakes due to over-thinking and unnecessary over analysis, the second block was better than the first one but it wasn’t good either, full of stupid mistakes due to loss of confidence and being paranoid after what happened in the first block.

I took the 2nd, 3rd and 4th blocks back to back, 15 minutes break, 5th,6th and 7th blocks back to back. I felt my brain was running like a jet.

From the 3rd block till the end everything went ok.

The following three weeks I was very depressed, I couldn’t accept that all my hard work has gone in vain. I’ve worked very hard for this but I messed it up, anyway. I had nightmares, one of them was –

There was a barber shop, I stepped in, and there was an elephant getting his haircut (Yes, an elephant😂😂😂) I sat next to him, turned my laptop on, and started solving step 1 exam 😁😁, in the middle of the first block this elephant said: “Hey buddy, you got this wrong.”

Me: “Excuse me!”

Elephant: “The answer is not Kozak consensus, it’s shine Delgarno, it’s a bacterium, not an Eukaryota cell you idiot.”

The next day I couldn’t sleep as an elephant called me an idiot, so who will be next to call me an idiot? a donkey 😂😂😂😂😂???

I’m sorry for this long post but I wanted to share my experience which might not be very beneficial as my score is not that good but I thought that I should tell what happened with me so you might learn something from it and avoid doing my mistakes.

Bullet Points

Don’t lose confidence during the exam whatever happens
Don’t be overconfident before the exam, just be confident
Do NBMEs inside out, study them don’t only solve them
Do your best not to get sick before your exam, yes, it’s not under your control but do whatever you can not to get sick, and if it happened, postpone your exam, I couldn’t, don’t force yourself in
3 Trust me guys, the exam is not that hard, if I got 243 with 5 and a half blocks only (as the first 1.5 blocks were a total mess), anyone can get 250s and 260s very easily, I’m not saying this to assure you or to encourage you, this is the truth

In the end, I’m happy with my score (a little bit disappointed) but thanks, god (alhamdulillah), I want to thank everyone in this amazing group, study hard, wish you all a better experience than mine, any question is welcomed, pray for me

Edit As a lot of people asked me about my preparation I’m going to answer here.

The Detailed Experience

Preparation time: 16 months

Main resources

Kaplan books – Twice
Kaplan videos 2010 & 2014 – once each
FA – 9 times
Pathoma – 3 times
DIT – Twice
Rx videos – once
UW – Three times
100 cases of Conrad Fisher
YouTube – This is a very underestimated source, I got qs from YouTube videos that were not mentioned in any of above resources, not even NBMEs (not a lot though so don’t panic)
Wikipedia – Helps a lot
MMRS – not recommended
Supplementary resources (didn’t finish any but used them to work on my weak areas only)

Goljan – first three chapters are gold
Goljan audio transcript 125 pages – gold
High Yield neuroanatomy
High Yield Gross anatomy
BRS physiology
Kaplan qbank – genetics, stats, pathophysiology, molecular biology
Rx qbank – only if you are a beginner and need something to help you understand FA
Kaplan q book – not very HIGH but anatomy is good, two blocks only but good
A Piece of Advice
Don’t be satisfied with getting the question right, but try to understand the concept inside out, this applies to any question whether UW, Kaplan, Rx, NBMEs

For example, if a question is asking about incidence rate of a mutant allele of autosomal recessive disease in population by Hardy-Weinberg equation, after answering the question correctly don’t move on, try to calculate incidence of the disease incidence of this disease in men if it was X-linked recessive, and so on…. make sure you understand every concept and how to apply it in different ways, do this for every question you solve, it makes a big difference

Good luck all.

Conversations with candidates

Congratulations! I think you did absolutely well given all the crazy stuff you had to deal with. Funny post too

Mahmoud – If you are talking about the elephant part, trust me it wasn’t funny 😂😂😂😂😂😂😂

May I ask if the clinical experience helps at all? Cause some of us if you go to Caribbean schools you have to pass Usmle step 1 before move on. I don’t know if a person without clinical practice get any disadvantages in term of reading and understanding the scenario better?

Mahmoud – it might help but I don’t think it makes a big difference

If I can only choose 1 Qbank to do, you would think UWorld is enough? My prob. is I read Kaplan 3 times and also studied, but I’m stuck right there and could not move on. I tend to forget what I study and just keep repeating the read.


How many qbank?? and how many times you solved them ?? Which NBMEs did you solve?

Mahmoud – UW 3 times, Kaplan qbank……DIDN’T FINISH, RX DIDN’T FINISH, NBMEs 11 TO 18

You did really well I believe you will get in the 270s in your CK. Your NBME scores are amazing too; what was your resources?

Mahmoud – Kaplan LNs ,FA ,UW,Pathoma,DIT,FA EXPRESS VIDEOS ,YOUTUBE ,WIKIPEDIA,100 CASES,FLASHCARDS. EXTRA RESOURCES (didn’t finish any just used them to strengthen my weakness areas) – Goljan, BRS physiology, High Yield Neuroanatomy, High Yield Gross Anatomy, MMRS, Kaplan q bank, Rx q bank, Kaplan q book)

Sorry, what is MMRS? and if I may ask, what specialty are you interested in? just curious. This shows that no matter what happens, no one can take away your knowledge/intelligence! I mean just look at your scores in spite of all this! – I shall keep you in my prayers for you to get whatever you want🙏cheers!

Mahmoud – thank you very much. Wish you the best too MMRS is Microbiology Made Ridiculously Simple.

How was immuno in the exam?

Mahmoud – Easy

Is First Aid + UW enough?

Mahmoud – I think it’s enough for the 40s may be low 50s if you do them right

What are the 40s and 50s?

Mahmoud – 240s and 250s

Where did u take ur exam

Mahmoud – Egypt

Could you tell us what material you used for studying ? also do u have any previous experience with publications and research?

Mahmoud – No research experience

But, why didn’t u delay, or report the official about the other guy, I mean I get it, delaying seems overwhelming when u have been doing good and maybe you deserved to be selfish that day and report the guy sitting next to u. Thank u so much for sharing such experience, but idk from some days I have been seeing this very often, Prometric not being good enough and being noisy, people getting sick before exam, GRE examiners making a lot of noise etc.

How to fight such things back idk, I really don’t; why don’t people especially the Prometric centre people fucking get it that this is once in a lifetime opportunity for us, if we fail, we are gone, if we leave in between we are gone, if we pass with a low score we are gone.

Mahmoud – I didn’t want to delay, I thought that if things went bad I would drop by 10 or 15 points and it was ok for me as I’m gonna get something like the high 50s or low 60s but unfortunately this didn’t happen

NBME 18 score 271 sent shivers down my spine. You can absolutely kill step 2 CK.

By the way, didn’t the guy beside you continue coughing in the subsequent blocks as well? 😅 This kept bothering me while reading the rest of your experience haha

Mahmoud – It was much better than the messy first block About 5 coughs/block which was okay 😁😁😁😁

Omg. Did u take any IQ test?? U are a genius. Congratulations

Mahmoud – I’m not that smart buddy, I have just worked as hard as I could

You surely made the right decision to stand up and continue .. your work hasn’t gone in vain there yet still you can do with such a great score … I know your potential is a lot more than this but it’s hard for someone like me to even comment on the hard work you’ve done but surely GOD is justice and you will find your hardwork in many different aspects of life.. Wish you all the best and congrats btw that’s an amazing score.

Mahmoud – Thank you. Wish you a better experience

Your experience motivated me to start studying again …

I just gave up after my Low performances in anatomy and molecular biology .. do u recommend something for these 2 annoying subjects. They’re bugging me.

Mahmoud – molecular biology: Kaplan. Anatomy: I wasn’t satisfied with any source but exam questions were easy. Strongly recommend youtube for both, it’s an amazing tool for whatever concept you feel weak at. I wish you come here again couple of months from now to tell us that it helped and you got an amazing 260+

God bless you … and thanks for the advice … I will just be happy with a 240 😄😄 .. hopefully

Mahmoud – shoot for the moon, if you miss, will likely end up among the stars. But if you get 240s, be careful of that elephant 😁😁😁😁

No elephants on my exam hopefully, especially the talking ones hahaha 😄

Mahmoud – 😂😂😂😂😂😂. Wish you all the best

Why would u wait for 4-5 months when ur NBME and UWSA were already so good? Congratulations on ur awesome score, I am just asking because I read many high score experiences with similar assessment scores from the beginning and I just wonder 1)how so good from the beginning 2)why wait so long. Thanks

Mahmoud – I wasn’t good from the beginning. My first assessment was 250+ 5 months before my exam but I was studying for about 10 months and solving q banks and q books

Now try to raise your self-esteem🙂 u did it right though

Mahmoud – Actually my self-esteem was really high but I lost it after the first block, so I’m working on getting it back now

Will u recommend Kaplan or just UFAP and NBMEs

Mahmoud – I recommend Kaplan if you have time, it’s gonna build very strong base for you

If u were to choose 1 between Kaplan videos and Kaplan lecture notes what would u choose?

Mahmoud – Videos for sure

After you’ll become a licensed doctor in the US and become a specialist afterward, you’ll laugh loud reminding on this elephant and donkey like we all did 😂 You have my appreciation and you should be proud of this points. They show your determination and that my friend with your hard-work will for sure take you where you deserve 🙂 Take care and good luck until the end of your journey. Thanks for sharing your experience, I found it very inspiring and motivating 🙂

Mahmoud – thank you very much for such nice words. I’m glad you found something funny in the middle of this horror movie 😂. Wish you the best too

Archana Sreekantan Nair – Don’t worry; I know you might be disappointed but u still got a good score after the roller coaster ride on exam day. Anybody else would have not come out alive from the test centre. You prevailed despite the tremendous challenge on your exam day. U were brave , u faced your fears and came out victorious. All your hard work will finally pay off. U have made a good foundation with step 1 preparation. U will go way ahead in your future tests. All the best.

Mahmoud – Thanks a lot.


Dr. Mahmoud Yousif


This article was first posted on Facebook. It was later edited and published here with the permission from the author.

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