As you can probably tell from my CBSE, I had a lot of reviewing to do. At my school the CBSE isn’t taken seriously at all and nobody prepares for it. I did put some effort into answering the questions just so that I knew what to expect going into dedicated, but I remembered almost nothing and basically had to guess on most of it anyway.
Hey everyone! This is my first time posting on reddit (ever), but I lurked on this sub heavily during my dedicated period and used a lot of its resources, so I figured I should give back now that I got my score today to show how much progress is possible to make in 6 weeks (and also because I'm excited and wanna talk about it ngl)
Step 1 score: 257
Resources Used: UWorld, First Aid 2017, Pathoma, Sketchy Micro (did bacteria only), Bros Anki Deck, aervien's pharm anki deck, Zanki for micro pharm (suspended any cards that had info not in First Aid)
Study Period: Exactly 6 weeks
Practice Tests:
School CBSE two weeks before dedicated: 57 (which is between a 165 and a 170)
UWSA1 about 2 weeks into dedicated: 232
UWSA2 about 2.5 weeks in: 239
NBME 19 3 weeks in: 244 (Since I heard the curve was brutal I made this my first NBME so that I wouldn’t get psyched out if I took it close to the test and got a bad score. Was very pleasantly surprised to get a 244 and had high hopes for hitting my goal of 250 on the next ones)
NBME 17 4 weeks in: 240 (Was very upset to score lower on what was supposed to be a much easier form)
Free 120 5 weeks in: 92% (Would def recommend taking it at Prometric so that you’re more familiarized with the process and relaxed on test day. Luckily for me they were offering free sessions at the time.)
NBME 18 the next day (6 days out): 244 (Was basically resigned to not hitting 250 on the real deal at this point)
First pass Uworld %: 70% (All random, timed, 40q. Averages started in the 40s-50s and progressed to the 80s for my later blocks.)
Pre-Dedicated: Prior to dedicated I didn’t prepare for Step 1 at all until the last semester of preclinical (ours is P/F 1.5 years) where I would read the sections of First Aid that corresponded with the unit I was in just to familiarize myself with the book. I didn’t really annotate or anything. I also watched Sketchy Micro during ID which is our last unit, which turned out to be a big help because I was already fairly solid on bugs before starting dedicated. The general advice I heard from upperclassmen was to not worry much about Step 1 until dedicated, so I took that advice and tried to enjoy my free time while I still had it.
My goal score going in was a 250 since it’d be safe for any specialty or program (the most competitive one I’m potentially considering is rad onc, though right now I’m leaning towards peds) and it’d be resistant against score creep since I’m an MD-PhD. I thought it could be attainable based on the fact that my school’s average is fairly high and I did well compared to my peers on our preclinical exams. As you can probably tell from my CBSE, I had a lot of reviewing to do. At my school the CBSE isn’t taken seriously at all and nobody prepares for it. I did put some effort into answering the questions just so that I knew what to expect going into dedicated, but I remembered almost nothing and basically had to guess on most of it anyway. There was a lot of stuff that I had known well at some point and just needed a refresher on (e.g. murmurs) and other stuff I had never seen before and knew I’d have to give extra time to (basically all of biochem and pharm which my school doesn’t really teach). I wasn’t worried about it at all until I came online and saw people scoring in the 200s on theirs, so I started worrying that it was impossible to reach my goal score from where I was. So my first piece of advice would be to not worry too much about the CBSE or how other people do on it! (Maybe unless you’ve legitimately been studying for it/it’s a big deal at your school).
Dedicated: I took a week off to chill after the end of preclinical and then got the ball rolling with studying according to the schedule I had laid out for myself. It was basically a heavily modified version of the second one on the First Aid website: https://firstaidteam.com/schedules/
The first week and a half was rough because I began to realize how little I knew and my Uworld blocks were terrible, so I started panicking. I pushed my first practice test back a few days because I thought I would bomb it and finally calmed down a little after I took it because it showed I was on track. I spent 4 weeks total doing a first pass of both First Aid and Pathoma, and it took me 5 weeks to finish my first pass of Uworld. In general I would spend a day to day-and-a-half per chapter of First Aid (two if it was a longer chapter or a weak one for me e.g. biochem, cardio, neuro) and the corresponding Pathoma videos (watched Sketchy for a 2nd time instead when I was on the micro chapter). I annotated both uworld and Pathoma into First Aid so that everything was in one place. I would take a half day off on Sundays and catch up on what I was behind on for the week. If it was a practice test day, I would spend most of the day taking and reviewing it and then take the evening off. My typical day was like this (though the timing changed a lot over the course of studying. Be flexible!):
7AM: Wake up, eat breakfast, spend some time on social media so that I’m not totally out of touch
8AM-10:45AM: Review First Aid and corresponding Pathoma
11AM-12PM: 40q Uworld block
12-12:30PM: Lunch (Meals were usually Trader Joe’s frozen food or something I had cooked in bulk on my day off)
12:30-2:30PM: Review Uworld block (this took more like 4 hours at the start of dedicated but came down to 2 hours as I became more efficient)
2:30-3:15PM: Go to the gym (tried to aim for 3 times a week) or take a Netflix break
3:15-6PM: First Aid and Pathoma
6-6:30PM: Dinner
6:30-9:45PM: 40q Uworld block and review
10-11PM: Anki then sleep. I found my Anki reviews impossible to keep up with and basically just jumped around between decks and crammed different subjects that I felt like I should that day. I got through most of aervien’s pharm deck and Zanki’s micro deck at least once. I also picked out cards from Bros’ deck on subjects that I was weakest on (Biochem, Pharm, Anatomy, Embryology) and tried to get through most of those too. I also made my own cards for concepts that I repeatedly got wrong in uworld or on practice tests (e.g. autonomic innervation of the pelvis) so that I could hammer them in and not get them wrong again on the real deal.
The last two weeks are really when my schedule started breaking down (as did my brain). There were multiple times where I felt like nothing was sticking and I would instead go for a walk or watch something on Netflix because I felt like I needed to reset. I tried to do a second pass of First Aid but it was taking way too long and I was burning out quickly. I eventually gave up on that and instead did a second watch of all the Pathoma vids, which were a lot easier to redigest. I also dedicated more hours to doing anki. I started redoing my incorrects on uworld during my final week but got through less than half of those. If I could go back I wouldn’t have attempted a second pass of First Aid and instead would’ve used that time to get through all of my incorrects, because there were many questions on the exam I was unsure of that I knew I had gotten wrong before in uworld.
Day before the exam: I reviewed my sketchy micro notes and did some pharm anki cards in the morning, but eventually gave up on that and decided it was time to chill out. I went to the gym, prepared for my post-test vacation abroad, had dinner with friends, and basically tried to enjoy my day. I thankfully managed to get a fairly decent night’s sleep that night.
The beast: My first section was brutal and I had to rush through the last few questions to finish on time. Took a few deep breaths after and tried to pace myself better on the other sections. If there was something I had never seen before or had no clue about, I basically guessed and moved on instead of dwelling on it and taking away time from other questions that I was more capable of answering. I probably marked at least 15 questions on my first couple of sections and that number began to drop by the last few sections. There were some marked questions that I changed literally seconds before time was up (which would almost always end badly for me in uworld but habits can be tough to break). Took bathroom breaks and/or snack breaks every two sections and took a longer lunch break after my fourth section. Overall I felt my stamina was really good for the exam and the whole day flew by. I walked out not believing I had just spent 6 weeks of my life studying for something that felt like it was over in a flash and really wanting a beer.
The wait: I flew out of the country for a week-long vacation the day after my exam and it was the best thing I could’ve done. It was hard to worry about my score because I was mostly worried about not getting lost in a new country and getting to see all of the sights. Would definitely recommend planning a vacation for right after your test date, though it can be risky in case you end up needing to push your score back. When I got back that’s when the post-test anxiety really hit me. I managed to resist the urge to look up all the questions I was unsure of, but for weeks I kept dwelling on this one steroid receptor freebie question that I knew I had stupidly gotten wrong. If I could get that wrong how many other things did I probably get wrong? I read all of the Step 1 experiences online that I could find to try to predict how things would turn out for me. My feelings ranged from “I totally fucked this up and did worse than my practice tests” to “NBMEs can underpredict a little and everyone feels like shit after so maybe I actually did hit 250” to “I just hope I get at least 240” and everything in between. When I got my score today I was totally in shock and thought I must have misread or that they sent it to the wrong person. Scoring well over 250 wasn’t even in the realm of possibilities to me. Still not really sure how this happened. I must have really gotten lucky and mostly missed experimental ones.
Final thoughts: All in all I feel incredibly lucky and relieved. But I also know that I worked really hard. Studying for this test is brutal and it’s gonna suck. There’s no sugarcoating that. Things that will make it more bearable:
Have a day-to-day study plan laid out before you start, but also allow for flexibility in case you fall behind or things aren’t working and you need to change up your methods.
Take regular breaks and don’t be afraid to take extra breaks if you really need them. You’ll always feel like there’s something more that you should be studying, but it’s impossible to remember every detail and you’ll be more efficient at studying when your mind is clear.
Rely on people to get you away from the desk/library and reenergize you, whether that be friends, family, or someone you’re dating. There will be the temptation to isolate yourself and it can be especially frustrating talking to someone who isn’t in med school and doesn’t understand how hard this is, but it would’ve been a million times harder if I had done it alone.
If you can help it, take it during the winter because you won’t be nearly as bumbed about not getting to go outside much (assuming you live somewhere with cold winters) and take it on a Friday because you’ll have a shorter wait for your score.
Be kind to yourself! Have that beer on your day off. Put in that expensive Seamless order. Whatever little things help you stay sane.
Happy to answer any questions!
Every NBME exam has questions that reappear in one form or another. These are the ones that I have identified. What do you think? Am I right or way off the mark? Did I miss anything?
neuromuscular junction
Tanner stage
heme synthesis
false positive/negative, reliability, precision, accuracy, cohort, cross-sectional, stratification
risk ratio or odds ratio
schizophrenia or depression length of time or bipolar 1/2 or anxiety
brachial arch or pouch question/digeorge
smoking is number 1 cause for....
A-a gradient
optic nerve lesion or hemianopsia
solid or liquid dysphagia
hematoma epidural/subdural/subarachanoid
lipid lowering drug
diuretic side effect
acidosis/alkalosis
succinylcholine or dantrolene
kartagener or cystic fibrosis
autosomal dominant or X-linked or mitochondrial
shock
recurrent bacterial/fungus/viral patient
hyperresonant or tactile fremitus
PLACES or SHiNE bacteria
thermoregulation peripheral vasoconstriction in prolonged cold
HOCM S4 AS or Dilated S3 AR MR
small cell lung carcinoma or carcinoid or serotonin syndrome
bullous pemphigus or pemphigus vulgaris
basal cell or melanoma or squamous/acanthosis
MEN 1/2
hyperthyroid or hypothyroid
myoma or rhabdomyoma
pleiotropy or polygenic or hetroplasmy
atropine or stimigmine or muscurinic agonist or anti-muscurinic antagonist
multiple sclerosis
Type 1/2/3/4 hypersensitivity, transplant rejection
cranial nerve or corneal or pupillary reflex
PCOS or menopause
hyrdrostatic or colloid pressure
PTH vs Ca levels
Vitamin-E,B12,B3, Fataxia, Syphilis related neuropathy or parietal cell antibody
nephritic or nephrotic or white casts or interstitial or kidney stones
SLE antibody or CREST antibody or scleroderma or Sjogren
RA or osteoarthritis or PAIR or dermatomyositis/polymyositis
toxin or antidote
lymph node drainage
hernia or hemorrhoid
developmental stage - roll, stand, walk, run, stairs
gluconeogenesis or HMP shunt
lysosome or mitochondria or proteasome or intron/exon
malaria or mycoplasma
sarcoidosis, Vitamin D, 25-something, 1,25-something, 24,25-something
CML or polycythemia vera or myelo
Meckel diverticulum or appendicitis or ovarian tumor or Hurschsprung
esophageal varices or Mallory Weiss or Boerhave
polyarteritis nodosa or temporal arteritis or Kawasaki or Reye
vesicular steatosis or nodular cirrhosis or Hep A, B, C, D, E, Hep B markers
Crohn or UC or Th1 or Th2
Blood smear - parvovirus B19 or Howell Jolly or Heinz or AML
Warfarin or heparin or von Willebrand or HUS or TTP
Blood group ABO classification or Thalassemia or Sickle cell
Multiple myeloma
muscle conduction Ca2+ or troponin or tropomyosin
albino or vitiligo or Leukocyte adhesion or Chronic granulomatous or tetrazolium blue test
random brain anatomy picture or dorsal column/spinothalamic tract/corticospinal
Sturge Weber or neurofibramatosis or Wilms or tuberous sclerosis
horners (constricted pupil) or uncal herniation (blown pupil)
random embryology from the heart or reproductive or a pudenal nerve
CO2 transport
asthma drug or cyclosporine or tacrolimus or other immunosuppressive
endocrine drug metformin, sulfonylurea
grade or TNM stage or brain to lung metastasis or colon to liver metastasis or prostate to bone metastasis, pancreatic adenocarcinoma osteoBlastic (unlike other cancers)
Km or Bioavailability or competitive/noncompetitive drug or maintenance dose or loading dose or volume of distribution or Phase 1 to 4 or p450, Anesthetic principles: blood solubility = induction & recovery; lipid solubility = potency = 1/MAC (always one of these lol)
Addisons or DI or adrenal cortical/medullary
post-ventricular MI complications
30s, 50s, aminoacyl transferase, resistance, beta lactamase, penicillin binding protein
Celiac or whipple
sexual transmitted infection (gonnorhea, chlamydia, syphilis, HSV, Haemophilus, vaginosis, Trichomonas)
anti-viral medication
cancer drug
GI drug
Type 2 pneumocytes
signaling pathway of hormones, p53, HOX gene, motif, tumor suppressor genes, oncogenes
Endometriosis, Leiomyoma, Adenomyosis, Asherman
amino acid derivatives, catecholimine synthesis
neuroleptic malignant vs serotonin vs malignant hyperthermia See here: https://s11.postimg.org/e456yj5k3/2011-11-15_113428.png
Collagen/Elastin/insulin synthesis. know in extreme detail
EDIT: Talo101990 shared some great ones.