Performance, Progress, Prediction

I started studying for the USMLE Step 1 back in January while doing my last semester of Basic sciences. It was hard to balance board prep with classwork, so I really didn't get much done during those four months. My real prep started at the end of May. I had a good  7 weeks of pure Step 1 preparation. Here is my performance on the practice tests I took:


Free 150: 80% (6 weeks out)


UWSA-1: 247 (4 weeks out)

UWSA-2: 265 (2 days out)

Cumulative UW average: 82% (first few blocks were in the low 70's, last few blocks were in the high 80's)

I didn't take any NBME's. Why? Because after paying more than $850 to register for the USMLE (as an IMG), I didn't want to spend another penny that would go to the NBME. It should not cost that much to administer an exam! With all the money they suck out of us, you'd think they'd take the time to update the software they use for the NBME practice forms! They don't! They use outdated software that was used years ago and is different from the current FRED 2.0 software they use to adminster the USMLE. You also have to pay extra if you want to find out your answers on the NBME practice exams (If I remember correctly, an NBME is about $40 without the answers, and $60 with the answers).

I went with the UWSAs because when you buy USMLE World, you can get the package that gives you access to the Qbank, UWSA1, and UWSA2 for $130 (1 month subscription). If you consider that the subscription to the qbank by itself is $99, that's like $15 for each UWSA, including answers, explanations, and software that is almost exactly the same as the FRED 2.0 software. Anyways, that was my rant for the day.

According to my performance on UW and UWSAs, my predicted score should fall in the 250's. Crossing my fingers for this!

What I wrote down on my laminated board

I wrote down a few mnemonics and facts that would save me time later during my exam.

• The drug receptors mnemonic in first aid: QISS QIQ SIQ SQS
• The Standard deviation curve (including the value for each interval e.g. from 0-1 SD is 34%, from 1-2 SD is 13.5% etc)
• I drew several blank 2 x 2 tables (you can use these for a lot of different things so it's good to keep them blank)
• The PT vs. PTT diagram in Rapid Review Pathology (i.e. which factors are tested by each test)
• I also wrote down 4 equations that I always forget.
• Css = (Rate in x f) / Cl
• Cl = Vd x k
• VA = (VT - VD) x f
• VD = VT x (PaCO2 - PeCO2)/PaCO2

 Overall, I think it was worth it to write all of this down before starting my test.

Looking back, which review books were most useful?

First Aid for the USMLE Step 1, 2010 (First Aid USMLE): Most of the questions on my exam were covered in First Aid. I would say about 80% of the questions on my exam were covered in First Aid. The remaining 20% were were based on information I read in other review books and annotated into First aid.

Pathology: Most of the questions on my exam were either straight Pathology questions, or Pathology related questions that tested other subjects. I had a few questions that weren't in First Aid or USMLE World, but were covered in Rapid Review Pathology. During my exam, I remember saying "Thank God for Goljan" several times.

Physiology: The physiology questions on my exam were straight forward. I had a lot of endocrine questions and a lot of "up and down arrow" questions. Physiology has always been one of my stronger subjects, so I didn't struggle with any of the Physiology questions. I think First Aid was sufficient for the Physiology questions, however sometimes First Aid lacks enough depth in explaining concepts (rightfully so, wince it's a review book), so I would recommend using another Physiology review book alongside First Aid, at least in your first pass through the material to help you understand the concepts better (I used the Kaplan Physiology lecture notes for most chapters, and sometimes used BRS Physiology instead). The Physiology questions tested broad concepts rather than obscure details, so that was good.

Anatomy: the Anatomy questions on my exam were difficult. There were some really easy ones that tested basic nerve lesions, but there were a few difficult questions that tested nerve/artery branches for example that weren't in First Aid or the Kaplan Anatomy Lecture notes. 

Biochemistry: I killed the biochemistry on my exam. First Aid was good enough for the most part. However, I felt that the Kaplan Biochemistry lecture notes helped me grasp Biochem concepts better. Some of the diagrams in the Kaplan lecture notes are essential. There was one genetics question I got that wasn't in First Aid but was covered well in Kaplan.

Pharmacology: All of the drugs on my exam were in First Aid. There was only 1 Pharm question that was in the Kaplan notes but wasn't in First Aid. The drug in the question was in First Aid, but the question was asking for a side effect that wasn't in First Aid.

Microbiology and Immunology: I didn't have any trouble with the Micro an Immuno questions. They were all covered in First Aid. I really don't recommend using anything else for Micro and Immunology.

Behavioral Science: I had a good portion of Behavioral Science questions on my exam. Several ethics questions, several Biostatistics questions, only one Psych question I think. I think First Aid is a bit weak in the Biostatistics department. I would recommend High Yield Biostatistics or the Biostatistics chapter in Kaplan.

Exam Experience

Let me start by saying how great it feels to be done with Step 1! It’s like having a two ton load lifted off your back. These past 7 weeks were tough, and I’m so glad it’s over. Now let’s get to the juicy stuff. Here’s my exam experience:


I woke up at 7:00 a.m. ate a well balanced breakfast and had my first caffeine dose of the day. I had to fight off urges to grab my First Aid book and look through some of the pages I had previously marked but didn’t have time to look at. I was feeling a bit anxious to get through the day, but I was confident in my abilities and I knew that I had studied enough to do well on this test. I grabbed my bag and stuffed into it enough food for a picnic:
• 2 club sandwiches (roast beef and chicken)
• Container of fruit salad
• Container of canned corn kernels.
• Bottle of Diet Coke
• 2 small bottles of water
• 2 Snickers chocolate bars
• 1 can of Red Bull

I arrived at my test center at 8:30. I signed in, had my fingerprints taken, and put all of my belongings (including my wallet, cell phone, and watch) in a locker. I was given 2 laminated boards and 2 markers. I honestly think they should rethink the marker thing because writing stuff out with thick tipped markers like the ones they provided wasn’t very feasible, especially when I had to write down equations and solve them. They should at least try to provide markers with thinner tips.

I headed over to my computer and signed in with my candidate number (you also have to enter your candidate number each time you sign in after a break). I started the tutorial and just made sure that my headphones were working. I skipped the rest of the tutorial. I wrote down some mnemonics and facts on my board that would save me time later (I’ll share these in my next post). I then took a deep breath and started my first block. The first 5-10 questions on my exam were VERY clinically oriented, to the point that I honestly thought that they had made a mistake and had me doing the USMLE Step 2! I made educated guesses for these first 5-10 questions and moved on. As I discovered anatomy questions and biochemistry questions, I quickly realized that I was overreacting and that this definitely was the USMLE Step 1. As I progressed through the first block, I calmed down and regained my focus. Overall, the 1st block on my exam was the second hardest block in my exam. I finished my block with 5 minutes to spare so I decided to take a 5 minute break to eat half a sandwich.

After pulling my pockets inside out to prove to the proctor that I wasn’t bringing anything into the test area, I signed in and went back to my computer to start the 2nd block. The second block was definitely the easiest on my exam. I finished it with more than 10 minutes to spare. The 3rd, 4th, and 5th blocks were also fairly easy (compared to USMLE World at least) and I finished with 7-10 minutes to spare on each block. I used the extra time to take well deserved breaks during the blocks to eat and keep my energy up. I had a can of red bull after the 4th block to keep my brain from shutting down during the latter half of my exam.

The 6th block on my exam was brutal! It was by far the toughest block on my exam. For most blocks I marked about 5 questions. On this block I marked at least 14 questions. I had 10 minutes of break time left and used it all after the 6th block. At this point, I had only 1 block left. I was so glad that this was my last block. Freedom was just an hour away. The seventh block was easy, and I was glad because at this point, my brain could only perform simple tasks. After my last block, there was a short survey I had to fill out. After being in that room for 8 hours, I honestly just wanted to leave. I filled out the survey and left the test room for the last time ever. I headed home satisfied with my performance, and already feeling anxious as to how I scored.

Let me finish by saying that time was never a big issue for me on the exam. The questions were just as long as the ones in USMLE World. I even had some 1-2 line questions. I always had more than 5 minutes to spare on each block (except for the 6th block, which I finished with 2 minutes to spare). So for those of you worried about the new exam format, don't worry! If you're managing your time well on USMLE World timed blocks, then you won't have a problem on the actual exam. I generally tried to pace myself at 1 question per minute. Check every 10 minutes to make sure you're on track. Half way through each block, I would always check to make sure that I still had more than 30 minutes remaining. If you're having trouble finishing a full USMLE World block in an hour, practice practice practice!

DONE!

I just got home from my exam and I'm EXHAUSTED! Overall, I am pleased with my performance. I know I did my best. I marked 5-10 questions per block. Since my mind is completely drained at the moment I won't be able to type up my full experience, but you'll get all the gruesome details tomorrow so stay tuned!

UWSA 2

I did UWSA 2 today. While doing the test, I felt that it was a lot harder than the actual USMLE World Qbank. Surprisingly I scored a 265! I don't know how accurate this is, but it's still very encouraging to score so high. All of my blocks were in the mid to high 80's percentage-wise.


With 2 days left I'm focusing on First Aid and looking at high yield images. I also hope I'll have time to look at some Neuroanatomy images from the UofT Neuroanatomy program.

My Second Simulated USMLE Step 1 Exam Experience

This time around, I knew what to expect! I knew when I'd feel tired and need a break, I knew when I'd need a snack, and I knew how I'd feel during each part of the exam. This experience wasn't all that different from the first one except in that I feel more prepared now, which is always a good thing 3 days before your exam! Anyways, I'm done with USMLE World now, I probably won't have time to do another pass of the questions I got wrong because I'd like to focus on First Aid.

This past week I've been marking all the topics I need to review again the day before my exam, and I'm going to continue to do that with the few chapters I have left in First Aid. I feel that I need to do another full pass of First Aid, but since that's not going to be possible, I should just focus on the other things I want to get done. At this point, I wouldn't ever consider postponing my exam. Yes I could do better with more time, but I'm just too burnt out to keep going like this. Another 3 days and that's it! I can't wait to be done with Step 1! Good luck to anyone reading this who is taking their exam this week (I know of a few who have contacted me). Stay focused and before we know it, we'll be done!

Get your melanin straight

++ melanocytes = Lentigo

-- melanocytes = vitiligo

++ melanin = freckles

-- melanin = albinism

++ nevus cells (modified melanocytes): nevus or melanoma

Simulated USMLE Step 1 Exam Experience

AI just finished my simulated usmle exam. I tried to pace myself closely, making sure I don't run out of time on blocks. I took a total of 1 hour break time and divided it as follows:

1st block
1 minute breather
2nd block
5 minutes
3rd block
10 minutes
4th block
30 minutes for lunch
5th block
5 minutes
6th block
10 minutes
7th block

My lowest point was the 6th block, I felt so exhausted during that block. I'm probably going to experiment some more with how I divide my break time. I still have enough questions for another full simulated exam.

I consistently scored in the low to mid 80's in all the blocks. I'm pretty pleased with my performance. I'd be ecstatic to do this well on the real deal.

A couple of points I learned from this experience:

• Eat a light lunch. I probably ate more than I should have for lunch and ended up feeling too laid back during the next block of questions.
• Look at the timer every 10 questions or so to make sure you're on your track.
• Don't get bogged down if you're not doing well. Like I said before, I felt so tired during the 6th block; surprisingly, it was my 2nd highest score.
• Focus on doing one block at a time. Before I started the simulated exam, I was like, "Ugh, this is going to take forever." I decided to just focus on getting through one block at a time.

Simulating the Exam Experience

I want to make sure I'm mentally prepared for the experience of taking an 8-hour long exam. I'm going to set up a simulation for myself today and make it as close to the real deal as possible. Seven one-hour long blocks of questions with 1 hour of break time. I even have some snacks prepared for my breaks. While I'm not looking forward to spending 8 hours on my laptop, I need to find out how this is going to feel so I can be prepared for doomsday. Wish me luck! I'll report back in 8 hours.

Recombinant cytokines

Filgrastim: gra = granulocyte; stim = stimulating factor

Sargramostim: gra = granulocyte; mo = monocyte; stim = stimulating factor

10 Days to go

With 10 days left, I still have so much to do. I've done 2/3 of USMLE World and 1/2 of First Aid, so I still have a lot to cover in the next few days.

This is definitely the time when you fell the stress, a word of advice to those of you at this point is to just focus on what you want to get done and NOT worry.