USMLE-Step1 experience, Ferial Tammam Alloush ,5th year medical

student , HU ,Jordan
Target : >260
Score:265  all glory to Allah
Exam date : 8/28/2017
Performance :
Preparation time :10 months (14 months with 4 month break (finals,
minors, travels, depression episodes :p)
though….inside the exam I realized that my preparation bagan the day I
started medical school….believe me or not ,I had an epidemiology
question from first year’s economics slides :p .. butterfly effect applies
perfectly here :p
when to start dedicated study ?
4th year was perfect for me … there is an outstanding similarity
between step1 and forth year subjects …I studied the last20 days of the
year (finals ) ,some minors , couple of days before each OSCE and had
almost the same GPA as previous years!
important point :try not to skip a single day in the hospital training …
step1 is a basic science exam …but it’s based on clinical vignettes…. You
don’t have to STUDY 4th year subjects (that’s a step2 issue)….yet,you
have to LIVE them and to build a clinical SENSE out of the (I think same
applies for 5th year )
“it’s all about FA and UW “ FACT or MYTH ?
Although I used to say that as an advice to everyone around me during
my preparation, I apologize … turned out to be a myth :p
In my opinion , step1 is never about knowledge ,it’s all about
REASONING ….REASONING…REASONING …. Can’t stress that enough
Dealing with ideas you’ve never heard of is the most important part of
a high score
The resource that can induce your frustration and curiosity the most is
certainly the best… which would be a Q bank almost a 100% of the
times:p
Knowledge can play a role during basic years… when it is stepwise …
but during your dedicated study period, books are usually useless!
UW can be a great source if used smartly ,
FA? Well, it’s important to start FA early on as it makes an organized
study frame … but I can hardly remember a single question in the exam
where I had to remember what’s written in pageX chapterY in FA !
Best thing I did ? starting UW too early (even before FA!)

Resources and schedule ?

first read ( july2016-1/1/2017) did not study that much in summer ..
then i started my dedicated study in september ..5 hours daily in the
library (2pm-7pm)
The best thing i did in my first read is integrating UW with videos and
FA ... it helped a lot fixing subjects into my mind…otherwise I would
have forgotten everything in the first read by the time I reached its end
Biochemistry : biochem is the only subject where i will say "videos are
more important than Uworld" Dr.Sam Turco 2014 kaplan videos are
outstanding
Two important points that would boost your score if you paid attention
to during these viseos are :
1- integration with other disciplines (for that reason i would
recommend doing biochem last not first during your first read .... as a
refreshment of what you've learnt previously)
2- try to steal the way Dr.Turco thinks ... he's so smart ... and his way of
thinking helped me a lot dealing with questions from other disciplines
... in short (try to be inspired by him )
Then you can do First aid and Uworld (i did UW bofore FA as the first
helped me to memorize the second )
Biochemistry was easy in the exam ... and the above resources were
more than enough

Molecular biology :
This was a really tough and high yield topic
I think the best approach is to try challenging yourself with as much
molecular biology questions as possible ... Uw , kaplan ,NBMEs , Rx ...
Then try to study the detailed explannation of each choice ...trying to
understand what's going on in the question writer mind
Also understanding the detailed genetics behind neoplasia section in
first aid is pretty helpful .... The mutations page in particular ... You
should look up for the detailed pathway downstream or upstream from
the corresponding mutation ... Not just the mutation itself ..
most of the questions in the exam were experimental in nature .. i
answered them by exclusion rather than knowledge ...

Behavioral science : (in order)

1-Dr. Daugherty videos (kaplan): i did them twice (no need but they
were really touching for me so i repeated them in the second read
when i was so bored ) ... key point here is not to overwhelm yourself
with details ... cuz almost everything you need is in FA,UW ... just try to
get the sense and the bigger pictures ... don't memorize a single word
2-100 cases in ethics ( not that important )
3-UW biostatistics subject review ( gold)
4- FA (rapid read) then concentrated read after UWorld
5- UW : great and more difficult than the real deal ... gold for ethics and
in my opinion much more important than 100 cases (my exam was
heavy in ethics , i had about 2 ethics questions in each block .. and
although i used to perform low in ethics in NBME ,ethics questions
were a comfort zone for me the exam day ... why ? Well,I reviewed all
uworld ethics questions 5 days before the exam .. and almost every
single question was covered there! )
Can't stress that enough... UW is best for ethics
Biostat was silly ... epidemiology was from outside the planet but you
can manage them by exclusion if you have practiced enough nbmes

Microbiology and immunology :

2010 kaplan videos followed by FA , kaplan Q bank(for memorization)
and UWorld
*no i did not do sketchy ! I did not like them
In the exam micro was the most difficult subject ! I was surprised by
how difficult and how plenty micro questions were ! ...and i did many
mistakes in micro .. but ended up with high performance in micro ! ..
the take home massege ( if you had a difficult exam don't panic ... your
margins of error would be wider)

Physiology ,Pathology , pharmacology :

Did them systemwise ...
1-kaplan2010 +pathoma (for path) followed by BRS
2-FA rapid read
3- uworld
4- FA concentrated read
Kaplan videos are bad for renal physiology so i recommend doing renal
physiology +nephrotic and nephritic from Dr.Najeeb videos ( i did them
during my basic years so did not need them in the first read )
In general i recommend Dr.najeeb videos for all basic years students ...
and i think he boosted my score a lot without me even being conscious
about that as i did his videos too early ( in second and third year )
Pathophysiology was hard in the exam with many many many new
ideas ... pharm was silly and direct from first aid
*and no .. i did not do goljan

Anatomy :
Kaplan2014 (gold for neuro) + shelf notes + FA + uworld
The exam was from none of these ... yet it was doable .... i
remembered a lot of ideas from dr.raith second and third year lectures
.. i owe him a lot here
(p.s. i thought before the exam that i have forgotten every single word
i learnt from the slides of second and third year ... but the adrenaline
rush inside the exam was able to boost my memory in a way that i
couldn't believe ... all glory to god…. So just believe in your brain under
stress :p
Second read:
1/1/2017-1/6/2017 (lots of interruptions here)
Nothing new ... basically FA and UW review .... with annotations of FA
with UW ideas (key but time consuming) , also i did 2/3 of usmle RX
offline (useless )
2 important issues here :
1- Spaced repetition(google it) : the second read consisted of 2-3 reads
by this method ... which helped me alot memorizing FA word by word
2- use things that keep your mode up because much of your time will
be on FA which is so boring ... i tried DIT videos ..they were time
consuming and boring as well ... at the end loud music worked best
(special thanks to Witney Housten , Melhem Barakat ,Dalida and Zeyad
Rahbani here )

Third read :
FA ,kaplan Qbank (nice but not that important ) i would recommend it
over Rx as it has some new ideas

Fourth read (and last )

1-FA with comparison to FA2017 as i used 2015 (that is a big mistake ...
i should have done that earlier )
2-60% of Uworld (timed mode, randomized)important to do uw till the
exam day as it keeps your mind on the track of critical thinking and
problem solving
3-NBMEs 6through 19 (1 every 4 days) also a big mistake and i should
have begun them earlier ... as important as UWORLD ! But much much
more stressful
(although the exam is more similar to UW in its format and looooong
questione that could not fit the screen :p , the pattern of thinking
required for the exam is more similar to NBMEs !)

Assesment tools : (UWSA>>160Qs, Nbmes>>200 Qs)

UWSA1>> 28 mistakes >>🤓266🤓 >>2.5 months off(overpredicts a lot)
Nbme13>>13 mistakes >>1month off
UWSA2>>12 mistakes >>🤓269🤓 >>1month off
Nbme18>>19 mistakes >>🤓252(online )>>1 month off
Within the last month
Nbme11>>7 mistakes
NBME15>>10 mistakes
Nbme12>>9mistakes
Nbme16>> 13 mistakes
Nbme17 >>7 mistakes (1 week off) >>🤓265 🤓online(most predictive for
me ! But too harsh in ethics)
Nbme19>>7mistakes
Nbme6-7 >> i did like thousand mistakes they are really based on
memorization and made me feel like i'm gonna fail so i would
recommend doing older Nbmes earlier as a learning rather than an
assesment tool
Note : i allowed myself 1hour instead of 1h15min for each block to train
myself on time managment ... as exam questions are longer ... and that
helped me a lot the day of the exam

NBMEs learning or assesment ?!

In my opinion they are both
Assesment tool in that they are so so predictive )at least for me )
Learning tool ?! No no wait :p .. i don't mean that you have to look up
for the explannation of each question and memorize the new info ..
that's for UW
What i mean is that they are the best tool to learn reasoning ... they
teach you on what to do when you are stuck in the corner ( which
would be the case in more than 20% of exam questions ) that's why i
would say NBMEs are key to high score
How can i learn that from them ? Well , you should look at your
mistakes +questions you were not confident with ... then try to analyze
what was going on in your mind When you solved that question
If you've got that question right then take it as a pervasive pattern of
thinking and apply it for all similar questions
If you've got that question wrong then try to analyze the question again
and find the best concept \trick to get it right
Don't go for google and look for the right "scientific" answer ... you
won't get the same question on the exam but you may have questionS
that require the same way of analysis
Another imprtant point is that they helped me to stay calm and
confident in the exam
Why ? Well, in my first NBME i marked like 15Qs per block and thought
that i would get 40 mistakes by the end of the exam but ended up with
13 mistakes only ... i thought i got them right by chance .. but when it
was repeated with each nbme ( marking like tones of Qs and ending up
with most of them right ) i realized that uncertinity is the rule .. the
exam is not designed for you to be familiar with each question .. you
will see new ideas .. new concepts ... new domains
NBME is the only tool to be ready for that
That’s why I felt I was doing well in the exam when I was actually
marking around 15 Qs per block

The exam day ?

One of the best days of my life
I went to the exam having only 4-5 hours of sleep for the previous 72
hours
In the morning i opened the prometric website thinking of postponing
the exam ,then i thought that 240 is okay and would get me an IM
residancy and decided to go on .. took some snacks and cofffee and
wore a comfortable bijama )best thing i did though i looked awkward
)... make sure that your bijama is wide as it will make your check in
faster and easier and save you some time
I started my exam at 7:30 .. i was so nervous .. but the first block was
the most easy and my heart stoped racing
Blocks were then getting harder , with each block being harder than the
one before
With longer questions and newer ideas ... but i was comfortable with
that
Breaks ?
Block1/2/3>> break >> block4,break ,block5, break , block 6 , break ,
block 7, freedom
I did not consume all my break time (had 10 minutes left ) ,.. time was
more than enough (had 7-20 minutes left with each block ) i felt i was
doing well ... the only bad thing i did is changing 5 answers ( all from
right to wrong ) .. but thanks god i ended up with 265 after all of that
Take-home massege ? Trust your NBMEs + it is normal and physiologic
to have insomnia the night before the exam(or the nights) .. the
adrenaline rush will do its job

Can i skip Kaplan ?

You might do that for some subjects that you are familiar with ... but in
my opinion ... Kaplan is crucial to high scores ... it builds a strong base
that you can't "see" but you will "feel" it the day of the exam ...

Best thing you did in basic years of medical school ?

Dr.Najeeb

Things you regret ?

Not doing the exam 2 months earlier ( 95% of your score is determined
by first and second reads ) repetition of FA in the last 2 month did
nothing to me
I should have started NBMEs in January and did the exam in June
the last read of FA
not completing the last pass of UW
‫في حكي هون و هون عن انو العالمة العالية مرتبطة بدراسة تجاميع و انو يكون نص‬
‫ صح وال الء ؟‬... ‫امتحانك مكرر من غيرك‬
‫ درست اربع تجاميع (قد ما اندق فوق راسي‬... ‫(برايي حكي فاضي‬
‫ و تاكد انو‬... ‫ في مية شغلة اولى‬.. ‫ فال تضيع وقتك ع هيك شي‬.. ‫تكررلي سؤال واحد براسو‬
‫مخك تحت ستريس االمتحان احسن من مية غوغل‬
‫ مشان هيك زكرتو‬... ‫هاد الحكي كان من اكتر االشياء يلي وترتني اخر شهر‬

Special thanks :") to :

Dad .. who stood by me day by day ,and was the best decision maker i
would ever have .. you was the furthest from me in distance but the
closest by heart .. and you would be forever in my Heart ... i have
nothing if i don't have you teko <3

Mom<3 ... i know i could have never performed like that without your
prayers supporting me all through the way ... and i wouldn't be in
medical school in the first place without your kind hands holding the
pencil for me when i was too lazy to write the alphabet myself... i have
the best mom in the world .. thanks widoo

saga ... well, that is the most strange delema in my life :p ... i have no
idea what good things I did in my life that she is still tolerating me as
the worst friend of her lifetime .... thank you so much Saga .. i couldn't
be there without you supporting me day by day by different scientific,
emotional , nutritional and logestic means ... sometimes I feel like you
desrve to be called Mama Saga
I love you more than words can describe

Heba and Marwa ... my year at the library wouldn't have been like that
without both of you ...
Heba ... the most kind and Deep heart of all times ... you and your
"maftool" tabarwers are so precious to me ….wish you a life that is as
pure as your heart <3
Marwa the person i have to talk to every time i decide to do a crazy
step in my life :p .. words cannot describe how beautiful you're inside
out

🤓My Bro ( khalood) ... you did a perfect job being jealous of me .. you
believed in me more than i did saying "٢٧٠ ‫"كذابة من يوم يومك بكرة بتجيبي‬
every time i said that i am late or i will do bad
I'm perfectly in love with all your perfect imperfections khaloody

Lamees the study partner of NBMEs and last month disasters ... i wish i
have known you for longer Lamees ...one of the kindest and most
clever people i've ever met
4th clinical group (Saga , heba , ebtehal , haifa , mohammad , abd ,
ashraf and ahmad ) thanks for tolerating my anxious mode the whole
year ... it have been a great year with you all

Good luck 