Step 1 Preparation and Experience

USMLE Step 1 257 Write-Up by Histoplasmosis Jones

Hi! I thought a lot about whether or not to do a write-up but honestly, reading people’s write-ups helped relieve a little bit of my stress during dedicated so I figured why not. COVID obviously affected my original dedicated plans and I ended up doing a lot more practice tests and questions than I otherwise would have. TBH this probably ended up working in my favor. I think the more questions you can do, the better. Personally, I got through all of AMBOSS once and through UWorld twice. The caveat about UWorld is that my school gave us access to it during M1 year so my first pass was used to study for class exams. I took about a 5-week dedicated period before my exam but, again, COVID significantly affected how much prep work I did before dedicated so I’ll try to explain as best as I can.

M1 year and first semester M2

I used Zanki and LolNotACop to study for class exams. Basically, I’d watch the relevant pathoma, read the relevant Costanzo, and watch the relevant sketchy for whatever we were covering, do the cards, and then keep up with them. I did my reviews every day, no excuses. I made sure my intervals were set so that no more than 3 months ever passed without me seeing a card. I think this was huge since most of the cards I got wrong were ones on the 3-month interval so I was glad to see those again. I think because of this setting, my retention rate was probably higher than necessary, but again, I felt like that only helped me not harmed me. Over the summer, I was less strict with myself about doing reviews but I still didn’t let them pile up too high before chipping away at them. One thing I did over the summer that I thought was helpful was to make sure that I finished watching all of the sketchy micro and did the relevant cards. Like I mentioned before, I did all the relevant UWorld while studying for class exams.

Second semester M2

At this point, I really was just making sure that I had covered all of Zanki/LolNotACop, finished UWorld, and focused on my classes! I also made sure to re-watch any Pathoma we had covered during M1 year just as a refresher. By the time the semester was over, I had finished all the new cards I had left and was focused on just doing my reviews. I had also finished my first pass of UWorld (including all my incorrects, which is HUGE!). A note on incorrects in UWorld, on my first pass I didn’t really make cards on information, but only because I knew I was going to a second pass during dedicated and would be making cards then.

Supposed to have started dedicated but COVID happened

At this point, I was very discouraged but I decided to take advantage of all this extra time and do AMBOSS. I thought this was a great idea. I loved AMBOSS, it was challenging but the explanations really made sure I nailed down the nitty-gritty details. I think these details, or at least being able to reason your way through these things, are essential to really killing it on STEP 1. So, every day I would do my Anki reviews and 80 AMBOSS questions. I also started taking a practice exam (old NMBEs) once a week just to keep in the mindset (didn’t do any questions on days I did a practice exam). I also had days where I did some UWorld questions just so I would have time to finish it and do my incorrects before STEP.


Every day in dedicated (except practice exam days), I would start by finishing my anki reviews, this was just how I always started my days because I found that if I waited to do my reviews later, I had a harder time actually getting them done. After that, I would do 3 blocks of UWorld, random and timed, and reviewed each block as I finished it. I would take notes and make cards on my incorrects. After UWorld, I would go over the concepts I found challenging that day in First Aid and make cards on those concepts, take notes, read up on, etc. I had a running list of things I wanted to review and just kind of went through those things when I felt like it. In the evenings, I would do some incorrects in AMBOSS or continue a light review of tough topics. Two days a week, I would take a half-day, and once a week, I would take a full day off. I thought this was essential to not burning out during dedicated and kind of help me reset my batteries! Some helpful advice someone gave me was that spacing out your half days/full days off so that you only ever have to do two full days in a row is great because you can think to yourself “I only have to get through today and tomorrow and then I get a half-day off” and that is really motivating.

Practice Exam Scores

✨ January CBSE: 228

✨ March CBSE: 236

✨ NBME 13: 221 (67 days out)

✨ NBME 15: 244 (56 days out)

✨ NBME 16: 244 (49 days out)

✨ NBME 17: 255 (42 days out)

Start of official dedicated

✨ UW1: 264 (35 days out)

✨ June CBSE: 253 (27 days out)

✨ NBME 24: 249 (21 days out)

✨ NBME 18: 248 (14 days out)

✨ UW2: 256 (7 days out) most predictive

✨ Free 120: 92% (4 days out)

Predicted: 254.5 (formula-based), 255.72 (date adjusted), CI 245-264

Actual Score: 257

Thoughts on Test and Closing Advice

The test is most similar to the free 120, I thought it was much easier than UWorld 2 in the sense that I had to do a lot less mental work to get to the answer. Most of my form was very straightforward and there were LOTS of repeat topics. For example, I had four or five questions on concepts related to metabolic acid/base balance. This is why it’s really important to have a good grasp on such a wide variety of topics because you never know what your form is going to harp on. Honestly, I walked out feeling very calm and relieved to just be done with this exam, especially after being canceled. I truly think the key to success here is repetition. I was able to take so many practice exams and I think that really helped because I was able to recognize patterns in question stems. This is also why I think that having two Qbanks was really great. Also, don’t get caught up in just churning out questions, make sure you’re really using those questions to their full potential, look at the images, read the other answer choices, make sure you didn’t just guess right and you really understand what they were getting at!

Preparing for this exam is one of the most mentally and emotionally taxing things I’ve had to do in my life and I think it’s really important to take time for yourself during the process and reset when you need to. I hope this is helpful for people.


Histoplasmosis Jones

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