Step 1 Preparation and Experience

It’s Possible to Score High on Step 1 While Working – Proved by Dr. Subuhi Kaul

Step 1 Score – 268

Year of graduation – 2012.

Prep time – 1 year (while working). Last 6 weeks dedicated.

Resources used

  • FA 2017 – two times.
  • UWorld – once subject-wise (did almost 70-80% of the OFFLINE UW). Online last 6 weeks.

Below are the subject wise books/videos used apart from the above two resources –

  • Anatomy: anatomy shelf notes and half of Kaplan videos 2015 by Dr. White (did these two in the last month). Did HY Gross Anatomy, HY Embryology, and HY Neuroanatomy at the beginning of my prep. I think these books are NOT required.
  • Physiology: BRS physiology
  • Biochemistry: Kaplan lecture notes
  • Pharmacology: Kaplan videos 2010
  • Pathology: Goljan book at the beginning of prep (do not recommend this) + Pathoma videos (last 2 months of prep) – highly recommend
  • Behavioral science: 2014 Kaplan videos + Kaplan lecture notes + 100 cases Conrad Fischer’s.
  • Biostatistics: Kaplan videos 2010 (Dr. Steven Daugherty) + Kaplan notes
  • Microbiology: CMMRS + Kaplan notes for Immuno part + Immuno part of 2014 videos
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NBME-18 (Online)8 months before examScore – 209 (54 wrong)
NBME-16 months before exam38 wrong
NBME-25.5 months before exam25 wrong
NBME-16 (Online)2 months before examScore – 244 (21 wrong)
NBME-151 months before exam24 wrong
NBME-19 (Online)10 days before examScore – 250 (14 wrong)
UWSA-2 (Online)UWSA-2 (Online)264

I realized 2 things from my NBMEs

I was improving with consistent study
I made careless mistakes because I did not cross check my marked questions and was always in a hurry to finish.


I started my prep in Sept 2016 and the first 4 months I was just lost! I didn’t know how to study.

In December or January, I started reading experiences and became a member of Facebook forums for Step 1. The exam experiences of previous test takers helped me a lot.

I started using Kaplan and offline UWorld.

I used to finish reading a subject from the books mentioned above and then do the corresponding part in FA and then the subject-wise questions from offline UW.

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This method remained the mainstay of my prep. I felt I needed to read or watch videos for each subject as I had forgotten a lot of basic science and then reinforced the subject by going through FA just so I was familiar with the FA style. Used UW questions to know what they expect us to know and how they asked questions from each subject.

This method was slow. I was working nearly 10 hours 6 days a week and I managed one month per subject.

But I regularly took NBMEs to see if I was improving. Since I was, I continued with this method until the last 6 weeks.

Last 6 weeks – I finished FA cover to cover once and did UW questions online.

I practiced one block per day like an exam. Did it in random timed non-tutor mode. My initial % was around 75 to 80. Went up to 90 to 100 by the end.

Even though people say we shouldn’t use UW as an assessment tool I found their progress graphs/reports very helpful. They encouraged me because I knew my studying was helping me improve. And also I knew my embryology and anatomy were getting my scores down so I managed to do half of Kaplan videos at 1.5x speed in the last month. (Couldn’t finish due to lack of time – wish I had).

In the last one week, I wanted to prep my mind and body to get used to sitting in one place and answering questions.

So I used the last 500 to 600 questions left in my UWorld q bank to help me do that. I did 4 blocks of 40 per day and then just went through explanations of the wrong or marked questions.

2 days prior to the test I took UWSA-2 as I had seen some experiences wherein it had predicted scores accurately. I was happy with what I got but felt I could do better as I had made silly mistakes because I was in a hurry to finish the test.

Exam day

I used the black screen mode (as I had been doing throughout with UW as I get a headache due to staring at a computer screen) – this helped me immensely. I had no eye strain and no headache even after 7 blocks. Used quick high energy food which would keep me full. Took frequent and short snacks and bathroom breaks after each block. Got lunch but was unable to eat it. So made do with chocolates, juices. Also took coffee at lunch-time so I could stay fresh till the end and finish strong. Finished each block with 15 to 20 mins to spare. Then went through all questions again carefully after finishing. Changed answers to a few silly mistakes.

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What you can learn from my experience

Even old graduates and people working full day also can do it (will take longer though)! Perseverance and regularity are key. Studying even 1 hour in the morning before going to work and doing questions regularly keeps your head in the game.
Do all Kaplan videos (barring pathology) once (I, unfortunately, was unable to do so).
Do Pathoma videos for Path (I didn’t do the book so can’t comment).
Use UWorld smartly in the last 1 or 2 months – use it to improve test-taking strategy. Read last two lines of the vignette first and then think of an answer\diagnosis in your head. Then go the answer choices and mark one. Just for completion sake read the rest of vignette cursorily to see if there’s any extra info which changes your answer. Start practicing this in UWorld for at least one month prior to the exam. This lessens the time taken to finish a Block thus preventing brain fatigue and gives you ample relaxed time to check your marked questions.
Just cramming FA and UW will probably get you a good enough score. But if you want an above average score (240+) you need to improve your basics.
I wish I had done all online NBMEs and checked the wrong answers. So please do as many NBMEs as possible even if it’s offline. Use them as an assessment plus learning tool.
I took multiple short breaks during my day (even in the last 6 weeks of dedicated prep). Watched the entire Game of Thrones season 7 (could not resist) and Modern Family cause sometimes I felt too overwhelmed or just didn’t feel like studying. But I never let a single day go by where I hadn’t studied something. Even if it was an hour.

Felt de-stressed and also guilty after my break and used to study better.

Everybody is different. And therefore what works for one person may not for another.

Find your path. Stumble and fall. Everybody does. But get up and keep working.

If you want it bad enough and work towards it. Nothing can stop you.

Thank your family for their support.

God bless and good luck everybody.

Doubts Solved by the Author

Q – Please guide what to do in the last week. – First aid, UW, and whatever was your weak subject according to your latest NBMEs.

Q – Did u give all nbmes? How to do uw in last week…I am really freaking out these days.😣😫 – I did NBME-19 10 days prior to my exam… uswa 2 in my last week. Apart from that I did like 4 blocks of UW daily… To get used to sitting and solving questions at a stretch . Did Anatomy Shelf Notes in the last week as that was my weak area and only managed to revise biochem and behavioural science from FA prior to the exam.

Don’t freak out 🙂. Trust in your nbme scores and just keep studying without thinking of ‘the day’.

Q – How many months u studied? – 12 months

Q – What is the highest score possible in step 1? I’ve heard there are 280 questions asked in the exam. So, is 280 the highest score? – No clue what the highest possible score is.

Everyone counts
Q – How did you study anatomy? – Kaplan + shelf notes

Q – How to improve basics as u said that it’s important for scoring beyond 240? What resources are most helpful in this matter? – Kaplan videos + notes and Pathoma videos

Q – And how did u find so much time while working…like any specific time management idea which may help? – I used morning time before going to work and lunch time while in the hospital. Also more hours on the weekends

Q – You did it while working so how many hours a day were you able to alot for studying? – It ranged from 1 to 4 hours. More on weekends. Sunday probably 6 hours.

Q – Really you are amazing… you inspired me. I was wondering and asking myself what I can do to give my step 1 while I’m working .really your experience gave me a lot thank you very much 😊 and wish you all the best with rest of you preparation and your whole life. – Thank you

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Q – How useful was BRS physio? – It was okay. Since I Didn’t read anything else for Physio except that and UW + FA, I don’t know if any other source is better…I didn’t do Kaplan videos. which I think should be done.

Q – Are you planing for step 2 or u have already done? – Will take 2ck in March end

Q – You are amazing you inspired me . I was wondering and asking myself that I can do to give my step 1 while I’m working…really your experience gave me a lot. Thank you very much 😊 and wish you all the best with rest of you preparation and your whole life. If there is any other recommendations I’ll appreciate it. note that I’m doing my internship year…thank you again and again – You can do it. Study Everyday. Slow and steady wins the race. Compete with yourself .

Q – Do you recommend 100 cases by Conrad? – Yes

Q – How much should I stress on ECG and heart & lung sounds? – Usually the vignettes helps in identifying the cases.

Q – Do I need to be good at calculations? – Calculations are easy.

Q – Please tell me how did you keep so much stuff in your mind till one year? You used to revise daily? Also how many months prior u choose the triad – That’s a problem I faced. I forgot pathology (which was the subject I started with) and anatomy completely by the end. So I watched Pathoma videos 2 months prior to the exam and did half of the anatomy Kaplan videos along with shelf notes. I had to revise these subjects

Q – What was your plan of revision in the last 5 days? – Well I planned on revising a lot more than I actually managed. Did FA. Biochem., Behavioural sci , immuno

Q – In the real exam, after completing one quick pass through all questions in a block (having about 20 mins left for second pass like you said). how many answers did you think you changed on an average during the second pass through the block? I am just having trouble improving my exam taking skills. Can’t seem to do a first pass that quickly. – 2 or 3 max (but not in all blocks). It’s okay. I’m used to reading large amounts of stuff in a short time. Take your time. I think even if you finish a block, with 10 to 12 minutes left, you’ll do fine. One more point is that I didn’t do the difficult\ time taking questions in the first pass. I felt more relaxed after getting through the block so did calculation based questions in the end. (Which was maybe 1 per block’).

Q – Please tell me what are the plus factors do u think makes difference between a 240 and 260+… awesome score 😍 – Understanding and applying concepts. Managing your time (during the exam) well.


Dr. Subuhi Kaul.

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