Exam Preparation and Experience Step 1 Preparation and Experience USMLE Preparation and Experience

Hope Keeps Dreams Alive by Dr. Dhakshitha Rao


Hello everyone,

I took my step 1 exam on Oct 24th, and received my score just now – it’s 243 🙂

I wanted to write this experience to all those out there struggling with the exam. Hopefully, it will motivate and give proper guidance which I lacked.

⌛Duration of My Prep

Time management
15 months (July 2016 to Oct 2017) I took a break of 2 months in between and again a break of 4 months later on for my rotations.

Total prep time is nine months (last two months dedicated period with 8-10 hours of study; other months I studied for 6-8 hours a day.)

📚Resources Used
FA and UW; added selected Kaplan videos (for biochem, immunology); Dr. Steven’s lectures for Behavioral Science; Pathoma videos; Kaplan Behavioral Science book; Shelf notes for anatomy.

I took a baseline test using NBME 12 at the very beginning – got 130 (June ending 2016).

I was doing my internship at that time – juggled between step 1 prep and the duties. Later I took off from the work when I couldn’t focus on the prep.

Started with FA and UW – took me six months to complete first round of UW with one read of FA (July to Dec.)

I took an online NBME in Oct (halfway through UW) – Scored 186. In December, after completion of UW, I revised everything and took online NBME 15 (score 225). Then a two weeks gap; reviewed the mistakes and took NBME 16 in Jan 2017 (scored 215).

That was when I realized only FA and UW is not enough for the exam. I made a note of all the subjects/ topics I was weak on and decided to do Kaplan videos/ Pathoma lectures to supplement.

Unfortunately, I had to take another long break of 4 months. So, I had to start again when I sat to prepare during July 2017. This time I solved USMLERx Q bank and gave FA a thorough read (2nd read) before taking an NBME. My NBME 17 was 215, two months before my exam. It completely shattered me. I lost all hope that I would at least get a decent score in 220’s as NBME 17 is supposed to be easy as per reviews.

I found a study partner to help me keep motivated and study the weak subjects – Pharma, Anat, Micro. At that time, I began with UW again, online. Did it random and timed mode – 2 blocks a day; added Pathoma book and Kaplan videos to my schedule. Took down notes and simultaneously did third read of FA. I also did one read of Shelf notes for Anatomy. I took NBME 19 halfway through UW (score 225). It was better than my NBME 17, and it made me push harder.

I took the Fred online – scored 83% ~ 230 and applied for the exam then – one month away.

In the last one month I completed UW 2nd round with FA. 2 weeks away from my exam, I simulated the real exam with NBME 18 and USWA 2 on the same day and Got 230 and 245 respectively.

The last week I revised the highly tested concepts and went for the exam.

USMLE Step 1 exam experience

📝Exam day

I took lots of food with me to keep me energized (make sure you do that; it can get tiring); the exam is a mix of USWA and UW. It seemed to me that the NBMEs are way different from the actual exam. The question stems are very long, and you need to practice time management, so it doesn’t overwhelm you.

For every block, I used to mark 10-12 questions (hard questions which included the WTF ones) and solved them at the end. I had 2-5 min left for few blocks and short of time for few others. So be alert throughout the entire time. You never know how it is going to be.

Suggestions (that I Learned from my Mistakes)

💡Do Kaplan lectures at the beginning – but space it for 1-2 months and not more than that. It will give you a basic idea on how to proceed with the prep.

Compulsory Kaplan videos are for subjects:

  • Biochem and molecular
  • Immunology
  • Physiology
  • Pharmacology – I preferred lectures by Dr. Raymon.
  • Behavioral sciences – Dr. Steven is the best. Do his videos.

Najeeb lectures are not necessary.

💡The exam is heavily image oriented. So make sure you prepare with images on a daily basis.

💡Try to avoid taking long breaks.

💡A study partner can help immensely in your prep. Find the right person to fit your study schedule and help you along.

USMLE Step 1 experience


🤔What is the best way to do UW for the first time?

Do it offline or online – really doesn’t matter. Take down notes/ make electronic notes (based on your preference)

But definitely use online to simulate for your second and 3rd UW read (if at all).

By the end of your prep, your UW average should be >85% for a decent score (the starting scores don’t matter.)

🤔Goljan vs. Pathoma?

Pathoma is the simplest and easiest way to up your score by 10 points. So do it. Do both the videos as well as the book.

From Goljan, I would suggest you do ALL the images and the short notes on the side. That is more than enough (I didn’t do this, but those points have some extremely HY stuff; if you have time go through it, if not only the images is enough.)

🤔Other Qbanks: Kaplan, Rx

I did Kaplan too for a few topics, but I wouldn’t recommend it, not HY. The only topics where Kaplan Qbank is helpful is for Genetics, Biochem, Anatomy

Rx Qbank – if you have trouble memorizing stuff, this will surely help. So base it on your level of capability.

📈My assessments all along

1NBME-12June 2016130
2NBME-13Oct 2016186
3NBME-15Dec 2016225
4NBME-16Jan 2017215
5NBME-17Aug 21, 2017215
6NBME-19Sept 10, 2017225
7FredSept 25, 201783% (~230)
8NBME-18Oct 12, 2017230
9UWSA-2Oct 12, 2017245
10Real DealOct 24, 2017243

✅Final advice

Trust your instincts more than your assessments. Don’t let the assessment scores demotivate you. Use them as a guide to push you further.

If there is anything I can help with or answer any questions, I will gladly reply.

Finally, but not the least, I have to thank my wonderful friends for all the help throughout my journey. Especially, my wonderful study partner Sarah.

USMLE Step 1 experience

🍁Doubts Solved by the Author

Q – Just love it. There are a lot of experiences that makes me feel so dumb. People started with very high scores in assessments, and I feel like…maybe it is not for me! I am old IMG, so I had to build all my basics. I took my first NBME online one week ago, and it was devastating as I thought I was better than that point. So, thank you for your experience at it makes me feel much better and with renovated energy. Congratulations!!

A – Don’t lose hope! The experiences with super high scores form 5-10% of all the step takers, and even less.

So, never give up. Keep working at it, and you get there! All the best for your prep 🙂

Trust your instincts
Q – Where to do images as you mentioned that test is heavily image-based. Are images in UFAP enough? If not then please suggest which subject’s images should be done by other resources

A – The images in UFAP are not enough. Pathweb is a good website to look into. Do radiology pics separately. Search for images in Google, as you read every topic. That should help.

Note – UFAP = UW + FA + Pathoma

Q – Congratulations on the awesome score… What would you say is more important, multiple reads of FA or UW? I know both are important but if you were to choose one of them.

A – I would say UW

Q – Plz can you tell me if I completed Kaplan lecture notes, videos, and FA; is it sufficient for the exam?

A – Take an NBME and assess to know where you stand. It will give you guidance on how to proceed.

Q – I’m exactly one month away from my exam date..scored just 200 in UWSA..I’m totally devastated….what do you think I can do to make it to above 230s?

A – USWA 2 is predictive as of present reports for scorers of 240-250. And USWA 1 overpredicts by 7-10 points. I would really recommend you to postpone your exam at this stage.

Take time to repeat UW and strengthen your concepts. The exam is concept oriented.

Q – Is it enough doing Goljan images?

A – Images from Goljan is enough; you don’t have to do the entire book.

Q – Congratulations, how was Anatomy on the exam? Any advice for what’s the best book for it.

A – UW + FA + Shelf notes is the basic

If you want to add more, you can do the clinical pearl boxes in BRS anatomy (but it can get overwhelming).

I tried HY anatomy but didn’t prefer it.


Dr. Dhakshitha Rao

A full-time doctor whose interests lie in Neonatology. She loves to inspire and motivate people to achieve their dreams. Her hobbies are writing and classical dancing.

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