I have some free time today so I figured it’d be a good time to finally write this post. After spending months alone behind a computer screen, sitting down at my laptop is my least favorite activity. It’s too nice out. Anyways..
Score: > 250
I’ve chosen to omit the exact score for the purpose of anonymity and also because I’ve grown tired of the neuroticism I see on the internet. It’s between 250 and 260. Could be on the high end, could be on the low. Doesn’t matter. As an elder recently reminded me, board scores are the gateway to an interview. The rest, the you, determines where (if) you are ranked, and ultimately where you match.
(Simply glance at the 2018 NRMP Program Director Survey to see what I’m talking about)
Before I dig into my preparation, let’s get a few things straight.
First, what worked for me may not work for you. Like any advice you read on the internet, absorb what you feel is good information and ignore the rest. Nobody is infallible. There are multiple routes to success. I would go as far to say that UWorld is the only resource you absolutely cannot do without.
Second, don’t define your success by an arbitrary number. You don’t need a 250. You don’t need to go into a competitive specialty. Leave your ego at the door, and gravitate toward what you enjoy. Not what will impress whoever it is that you’d like to impress on match day. One person may be disappointed with a 240, while it may be your dream score. And there is nothing wrong with that. Forget about everyone else; you’re competing against yourself. Everyone should strive to do as best as they possible can on this exam, but remember, please remember that the three digit score can vary a decent amount depending on how you perform on actual test day and which 280 questions they generate for you. Learn to love yourself. This test is a game and it should never determine your happiness. Work as hard as you can. Beat the test. And move on.
Before we dig into the when & how, here’s the list of resources I used. I’ll write a post reviewing each of the following resources, but for now I’ll just give a brief synopsis of what I used:
- Boards and Beyond: main resource, watched each video. 10/10.
- First Aid: Used as reference pre-dedicated, read one full pass in dedicated.
- Pathoma: Didn’t truly start until second week of dedicated, watched maybe 75% before realizing I was wasting my time.
- Sketchy Micro: Finished maybe 80%. Mostly d/t procrastination.
- Sketchy Pharm: Watched like 6 videos. Hated it. Don’t @ me.
- Anki: Made my own Anki deck based on B&B. No Zanki or other outside decks. Didn’t feel they were efficient. Also made an Anki deck on my UWorld and NBME incorrects plus little facts in dedicated. Highly recommend.
- USMLE Rx: Did one full pass, started in September, finished in February.
- UWorld: Started in February. Completed one full pass at 75% correct pre-dedicated. Completed incorrects during dedicated.
- Goljan Audio: completed one full pass on car rides/commutes throughout the year. Loved it.
I’ll construct this post like a timeline. I’ll write what I did and when. Again, please do not feel the need to follow this timeline and strategy word for word. There are many routes to success. This is simply one of them…
I didn’t even know what First Aid was for the first few months of medical school. I found Pathoma after a few blocks. I used Brosencephalon Anki deck for like a block or two. After getting my bearings, I’d watch class lectures from the comfort of my home, made my own Anki cards based on the lectures, and maybe read some First Aid/Pathoma to supplement. I scored towards the top of the class in M1. I looked at boards stuff, but I wasn’t studying for boards. It ended up being a very fun year and I learned more than I ever thought I was capable of.
Summer Between First and Second Year
Opened Sketchy once. Watched like two videos. Closed it and never opened it again. I spent my summer with friends, going to concerts, musical festivals, hanging out with family, my girlfriend, swimming, drinking, cooking out, lifting weights, watching movies, traveling to visit friends, barbecues, writing, reading. I did manage to get my research published. So that was great. It was an incredible summer, a welcomed cleanse from medicine, and a rejuvenating preparation for the marathon of second year. I didn’t study over the summer. And I am so thankful I didn’t. It would have been completely wasted time.
Fall of Second Year
After not thinking about boards or medical school (aside from a light research project) over the summer, I tried to formulate my plan upon returning to school for M2. I researched, scoured Reddit threads, talked to elder students, and crafted a tentative strategy. Starting with my first block of M2, I purchased USMLE Rx question bank and did the associated questions for the block. I also stumbled upon Boards & Beyond and used it watched Dr. Ryan’s videos for the block while searching through First Aid via PDF for reference. Watched some Sketchy vids here and there.
(In a future post, I will break down and review all the resources I used)
For the first couple months, I simply did my best to learn class material thoroughly via class lectures and board resource (FA, B&B) supplementation. My goal was to make sure I knew all board-relevant information cold at the end of each block.
In November, I switched from a class-first-boards-second approach to pure board-mode. I spent 90-95% of my time learning (and re-learning) M1 material via Boards and Beyond while spending that last 5-10% flipping through Powerpoint slides, mostly in the week leading up to the exam(s).
For example, say that was Renal block (it wasn’t, but.. ~anonymity~) and let’s also say it was a five week block; I’d spend the first two weeks covering the renal videos in Boards and Beyond. I’d make my Anki cards for the block. I’d spend weeks three and four relearning something else (eg, Cardio, GI, etc) while doing the Anki cards. Then I’d zip through all the class lectures via Powerpoint slides in the week (more like days) leading up to the final exam. I would also do the associated USMLE Rx questions while in the block.
My goal was to master the board-relevant info for a given block with board review resources (namely B&B) while doing just enough to stay afloat and pass my classes. Boards and Beyond is a very comprehensive video series and Dr. Ryan is a fantastic teacher, making it the perfect “primer” to lay the foundation for the spring, and ultimately, my dedicated board prep period.
Now, I feel it’s important to touch upon my Anki deck. The first first-year subject I reviewed in Boards in Beyond was Neurology to kick off my board prep. I watched all of the Neuro videos in B&B (many 2-3x) and completed all USMLE Rx neurology questions, but a week or two afterwards, I realized that I had quickly forgotten most of it. Therefore, I decided to start making a “master” Anki deck of material I learned in Boards and Beyond. I did this with major discretion, careful not to overload myself with cards on stuff that I felt was easy, intuitive, or super low yield.
I am a big advocate for making your own cards. I was never a big fan of the pre-made giant Anki decks that caused me to spend my day ripping through hundreds of cards on trivial minutiae. However, I do understand that many have used these decks with success. It just wasn’t my style. And in this process, sometimes you have to learn that this is okay and do what feels right for you.
Anyways, I created the deck to be more challenging, and focused on making fewer, harder cards. I felt this helped me learn way more efficiently than Zanki or any other alternatives. Moreover, I liked the idea of being able to recite a “list” cold and I felt this really helped me master certain topics. For example, I haven’t opened Anki since mid-June, and just today my attending asked me what the risk factors where for a certain condition. I was able to rattle off a list of seven without thinking because of those cards, even if they were painful to memorize in the beginning.
Spring of Second Year (Pre-Dedicated)
Kept doing what I was doing for the first month of the spring semester. I had heard many conflicting opinions on when to start UWorld during M2. I decided that I wanted to do two passes of UWorld, so I started in late February with plans to finish my first pass right before dedicated. If I could go back, I think I would have waited a little longer.
When I started UWorld, it took me a very long time to review a given block. I’m talking like 4+ hours for a 40-questions block. I began by writing quips, facts, and tidbits in a UWorld notebook. I’d fill up 3-4 pages front and back with notes. This was stupid, however, because it consumed way too much time. And I never felt like reviewing them. And my handwriting looks like drunken college bar bathroom wall chicken scratch.
Plus, when you haven’t covered everything yet (even a brief first pass), it takes longer to review a given UWorld block because there is more information that you don’t know. Consequently, spending this much time reviewing UWorld questions meant that my progress in Boards and Beyond had slowed immensely. In hindsight, I think it may have been a better idea to finish Boards and Beyond (my first thorough review of all material) before starting UWorld. I think you get more out of UWorld when you have a solid background/understanding of the question. Plus it’s more efficient.
I continued this pattern until dedicated. So in the spring leading up to dedicated, an average day looked like this:
- Wake up, blend a smoothie, watch a Boards and Beyond video or two, knock out some Anki cards to get my brain warmed up [1 hour]
- UWorld block [1 hour]
- Start review of UWorld block [2 hours]
- [Insert some mandatory school activity for two hours]
- Come back home and procrastinate [30 minutes]
- Finish UWorld review [2 hours]
- Boards and Beyond [3 hours]
- Pick up take out dinner at like 9-10 pm because every day was a race to study as much as possible before bedtime, and sitting down to eat meant taking a break.
- More B&B, or getting lost in random internet rabbit holes [1-2 hours]
- Bed (aka lay in bed on my phone for two hours before falling asleep)
I repeated this process daily, subtracting the mandatory school activity and adding an extra UWorld block on weekends. By the end of the spring semester leading up to dedicated, I had finished my first pass of UWorld, (mostly) completed Boards and Beyond, and watched about 50% of Sketchy micro.
six five weeks)
- 6 weeks out; NBME 15: 248
- 5 weeks out; UWSA1: 257
- 4 weeks out; NBME 16: 252
- 3 weeks out; NBME 17: 260
- 2 weeks out; NBME 19: 253
- 1 week out; UWSA2: 249
- 3 days out; NBME 18: 248
- 1 day out: Free 120: 86%
Notice the pattern. My first NBME practice exam and my final NBME practice exam were exactly the same, yet separated by a month of studying. One may guess that I wasted my time during that month (and yes, much of it was wasted), but that is not the reason I didn’t progress. Frankly, beyond the personal issues I was dealing with at the time, when dedicated arrived, I had studied enough. I was almost there.
Week 1: I didn’t really do anything during the first week of dedicated (if you’d like to waste some time, read more on why here). So, lets check out the practice scores.
Weeks 2-4: While making my tentative schedule for my Step 1 study prep, I planned to finish Boards and Beyond about two months before my exam and switch over to Pathoma for the final two months. That didn’t happen. I finished all major systems (cardio, neuro, etc) in Boards and Beyond prior to dedicated but still hadn’t completed a few of the other minor topics (stats/epi, basic pharm, behavioral science). During weeks 2-4, I went through those sections in B&B.
Furthermore, I had planned on completing Sketchy Micro and Sketchy pharm and ultimately using Sketchy as my major resource for those topics. As it turned out, I absolutely hate Sketchy. I had watching the videos. It always felt like a chore to me. Don’t get me wrong – Sketchy is a phenomal resource and the videos that I did watch stuck with me. However, I hated it, and I’d literally rather read First Aid pharm sections three times over than watch Sketchy Pharm once. It just wasn’t for me.
So, I decided to go through the Infectious Disease chapter of Boards and Beyond while annotating notes from Dr. Ryan’s lectures into First Aid. This was sufficient for all micro and pharm on my exam. Again, Sketchy is awesome, but it wasn’t for me. I should have started it earlier, but I procrastinated and finally said screw it. And what do you know… it all worked out in the end.
I also started watching Pathoma. While watching Pathoma, I’d write down notes and draw out pictures in the margins on the side of the book. I also made Anki cards for any info that I didn’t know or wasn’t in B&B. I finished about 75% of Pathoma because it was considered sacrilegious to not watch Dr. Sattar’s Step 1 gospel. According to the internet, that is. Aside from the first three chapters– It was good review, but largely a waste of time. I felt that the combination of Boards and Beyond and my first UWorld pass taught me 98% of the information in Pathoma. Again, I felt that the first three chapters were essential, but beyond that point, I should have quit on Pathoma a little earlier.
During weeks 2-4 I also did UWorld incorrects and marked. Again, I had read that it was a wise move to do two passes, but I quickly realized that going beyond incorrect was also a waste of time. I was flying through each block, scoring 90% at a minimum, and still devoting an hour or two per day towards reviewing blocks. While I did pick up on some new bits of information, I simply remembered too many questions from my first pass.
Weeks 5-6: During the home stretch, after completing Boards and Beyond and scrapping Pathoma & UWorld from my routine, I didn’t know what else to do. So I decided to crack open ol’ faithful – my hard copy of First Aid. Throughout the year, I had been using my PDF file of FA as reference more than anything else (if I watched a B&B video on a topic, I’d check out the relevant pages in First Aid and look for discrepancies and clarification).
Because I had two weeks left and nothing “new” to cover, I decided to just start reading First Aid. This was actually super helpful, and it’s something I wish I’d done sooner. Anki is a godsend. Dr. Ryan and Dr. Sattar are heroes. Question banks are essential. But actually reading First Aid, like sitting down and just powering through the Cardiology chapter, was extremely beneficial. I did this with a myriad of colored sharpie pens, taking little notes along the way and underlying little points that I had neglected in my previous studies. It was a great way to strengthen weaknesses and build confidence quickly.
Final Week (week 6 – test day): I continued going through First Aid as I previously explained. But at this point, my previously roaring bonfire of motivation and mental sharpness had burned down into a weak little nest charred embers. I had nothing left in the tank. I was sick and tired of studying. And I was reaching the point of diminishing returns.
I sat down a week before my test to take UWorld Self-Assessment 2. Considering I’d been hitting my stride with NBMEs (252; 260; and 253 on the dreading NBME 19), I thought that I’d crush it with a 260+ (after all, most people said it was supposed to over-predict). I struggled through those four UWorld blocks and scored 249 – my lowest practice test score since day 1 of dedicated. I spent the afternoon reviewing and realized I’d made quite a few screw-ups on “easy” questions. Especially during the final two blocks.
This stressed me out pretty bad, and I had become pretty neurotic about he predictive value of practice test scores (btw, do not do that…). As I’ve written in a previous post, I was staying up until 3-5 in the morning, eating like garbage, and not really taking care of myself. I was scheduled to take the test on a Tuesday. On Thursday evening, chills swept over my body, I had a high fever, and spent the night wrapped in blankets unable to get up out of bed. After spending the next day in bed until the afternoon, I decided to drive a few hours so I could at least be miserable in the comfort of my home with people around to help me out (thanks mom!).
As you can imagine, with the exam a few days away and stressing about my recent practice test score, anxiety was a solid 10/10. I took NBME 18 Saturday in attempt to redeem myself and head into the exam with confidence. I was shivering and wrapped in blankets at my kitchen table and unsurprisingly scored even lower – 248. While this is a great score and nothing to complain about, it is disheartening to put in so much work only to see those numbers decline.
I was feeling much better and took the NBME Free 120 practice test on Monday. Scored an 86% which roughly averages out to around a 246 (for most people). I was debating moving my exam back a week, maybe even two, until I realized that I was being a complete idiot (what’s new). I reviewed my last three exams (UWSA2, NBME 18, Free 120) to look for a pattern; I tallied each missed question into one of two categories:
- Knowledge deficit: aka the answer was in review resources (FA, B&B, etc) but was something I didn’t know/remember
- Stupid mistake: I knew the answer, but simply screwed up in some way (usually via overthinking or forgetting something basic/easy).
Roughly 80% of my missed questions were due to making stupid mistakes. I was becoming fatigued by the end of practice tests. My reading comprehension was regressing. I was overthinking straight-forward questions (“oh, this question is easy therefore the exam writers must be trying to trick me” – wrong). And finally, I was starting to forget extremely trivial things when faced with the questions in the context of a timed exam.
Studying for Step 1 is a bit like being a professional athlete. You train for a long time. You become really good at your sport. You have a period where you’re in your prime. The best you will ever perform; the best you will ever score. Then your skills start to fade. You want to be like Jim Brown, Earl Campbell, or more recently Calvin Johnson and Patrick Willis – finish when you’re in your prime so you don’t end up like Brett Favre. It’s hard to predict, but if you’re studying constantly, you will hit a peak which hopefully times up to be at the end of dedicated on your exam day. I toyed with the idea of moving my exam up (I wish I had in hindsight), but I’m thankful I didn’t wait any longer because I truly believe waiting another week or two would have lowered my score.
After reaching this realization, I made peace with the fact that I had worked incredibly hard for this test, and I was going to take it. I didn’t sleep much the night before the exam (who actually does?), but adrenaline and caffeine powered me through the first half or so. I felt the familiar fatigue by the last few blocks, but it all worked out in the end.
I wrote much more about the actual exam day the a few days after the test when everything was still fresh, so if you’d like you can read that here.
So, there’s my Step 1 study timeline (in entirely too much detail), but here’s a short version for summary:
- M1: Worked hard in classes, used some Step 1 resources for reference
- Summer between M1 and M2: Nothing. A beautiful time in life 🙂
- M2 fall: Implemented Boards and Beyond and USMLE Rx into class lectures. Started truly studying for Step 1 and reviewing M2 material (via B&B, Rx, and creating my own Anki deck) during November. Watched Sketchy micro videos here & there.
- M2 spring: Continued what I was doing, finished USMLE Rx in February and started UWorld. Completed my first pass (75% correct) as dedicated was starting. Finished maybe 80% of Sketchy micro. Pretty much never stopped studying 😦
- Dedicated: Practice tests (UWSA1 & 2, NBME 15-19, Free 120) every 6-7 days. Did UWorld incorrects. Completed about 75% of Pathoma. Finished watching minor topics (stats, etc) in Boards and Beyond. Read First Aid cover to cover, reviewed weak chapters in the days leading up to the exam. Did my Anki deck daily until roughly a week before the exam.
- Scored over a 250
- Enjoyed life and re-entered the world 🙂
For further reading, check out my recent post: What I Did Wrong and What I’d Do Differently
Stay Tuned for Future Posts on…
- A review of all resources I used
- A guide to getting the most out of Boards and Beyond
- Starting clinical rotations
- And much more