USMLE step 1 experience by dr.Rose Bila - 243

My USMLE step 1 experience-Rose Bila: Step 1 score 243 received on 02/06/19. I know that it is too long but I wanted to be as comprehensive as possible.

Hello my USMLE Step 1 family! Rose is my name on my baptismal certificate but Rose didn’t make it as my name when I started school.

My journey is not typical. I am 40 years old IMG and I graduated 

in 2003. I am married and I have a 13 year old son. I have a green card and I am applying for citizenship ASAP. After graduation I practiced medicine (seeing patients) for 5 years. From Sep 2007 to Aug 2008 I got a Masters degree in Public Health from Europe; after which I worked in clinical research until January 2014 when I migrated to the US. In August 2014, I started graduate school full time (PhD in Microbiology) and I am still in school. Hopefully, I will finish this year now that Step 1 is out of the way.

When I came to the US, I had no intention of practicing medicine. I just wanted to do research hence the reason I enrolled in the PhD program. The first two years I was just in class learning and I didn’t do any wet lab. I did look at an old FA and some USMLE type questions and I thought that there was NO WAY I COULD EVER PASS THE EXAM and I didn’t bother with it. In Spring Semester (2016 Jan to May), I started doing wet lab and I didn’t like it at all. This is when I thought about doing USMLE in order that I may do residency and maybe do clinical research instead because I was doing clinical research and interacting with patients in Africa and I really enjoyed it.

How I studied.

Total study time: 2.5 years (June 2016 to Jan 2019) with lots of breaks and distractions.

Dedicated, full-time USMLE study: 6 weeks.

I joined this forum in May 2016 under my real names. I downloaded and saved offline UWORLD from this group and my friend gave me Dr.Najeeb videos. I watched Dr. Najeeb videos and went through offline UWORLD whenever I had a chance. I was definitely not consistent and I can’t say I studied for even a total of 4 or 5 hours in a week. I went through FA 2016 with out annotating anything. FA seemed like an alien!! Of course, I didn’t know the answers to most of the UWORLD question and I didn’t understand some of the explanations, but I kept on going even though I was inconsistent.

In January 2017, I decided to get serious. I deactivated my legitimate Facebook account and created a new one under my fake name. I uninstalled twitter and Instagram from my phone. I did this because social media is a great distraction for me and I didn’t want any distractions considering I had a lot on my plate. I used my fake account to join this group and didn’t accept friend requests under this account because I didn’t want to be distracted by people’s non-USMLE Facebook life.

In May 2017, I subscribed to Boards and Beyond for one year but planned to take the Exam in August 2017 if possible because I thought that 3 months of dedicated study would be enough for me to ace the exam (How intelligent did I think I was???? Delusions of grandiosity!!!). I even went online and applied to take the exam and paid for it but my application was rejected (the second best thing that ever happened to me in this journey) because I hadn’t submitted any of the required paperwork; dumb I know!!. I eventually got the paperwork done but it took a long time because my names are arranged and spelled differently on my Green Card, degree certificate, and transcript and my school had to send the Name Verification letter three times; {story for another day….}). Also, my professor called me back to work in the lab in the summer and thus my plan for 3 months of full-time study wasn’t going to work anyway. In August 2017, I subscribed to Pathoma for 1 year. I therefore continued to watch B n B and Pathoma whenever I had time and continued to go through offline UWORLD as much as I could; on average maybe 2 hours a day. From my B n B subscription, I downloaded, saved and printed B n B PDFs of lecture slides. I realized that Pharmacology was my weakest subject ever. In December 2017, I took 2 weeks winter break and used this time to watch Kaplan 2014 Pharmacology videos online. I found the link in this group. I didn’t know how to speed up the videos so it took me the whole 2 weeks but this was very helpful to me. From then, at least some of the pharmacology questions didn’t seem like they were from outer space.

In January 2018, I bought FA 2018 and ripped it apart and put 2 to 3 sections in each 0.5 inch binder for a total of 9 binders. I carried one binder at a time to school to read and I tried my best to read FA for at least an hour a day and the corresponding UWORLD offline for an hour as well with more intense reading over the weekend. This time, I annotated my FA with UWORLD material. I googled everything I didn’t understand and annotated the explanations in my FA. Around this time too, I saved Dr. Najeeb videos on my phone and I bought Bluetooth earphones and listened/watched (mainly listened) to these videos while driving to and from school everyday; 45 to 60 minutes each way so that even if I didn’t have any other time during my day to study, I still ‘studied’ something for 2 hours. Another friend gave me Pathoma 2013 and Kaplan 2014 videos offline. In April 2018, I came across B n B videos on this forum and I downloaded and saved them on my laptop. I saved B n B and Pathoma on my phone and would listen/ watch while driving instead of Dr. Najeeb. I would put my phone in a phone holder on my windshield. To everyone else, it looked like I was using my phone for GPS Navigation. I didn’t renew my B n B and Pathoma subscriptions when they expired.

In June 2018, I paid for UWORLD for 2 years. This just goes to tell you how much I thought I wasn’t going to be able to take this exam anytime soon. However, this was the best move I made. I started doing on average 5 blocks a week in random mode and annotating my FA. My scores ranged from 55% to 85%. By the time I finished first pass of online UWORLD, my average score was 70%. I only did system/subject wise a couple of times; only the systems/subjects that I was consistently failing in random mode. I remember I did Pharmacology, Behavioral after doing 100 cases, CVS, and Neurology in this mode but only until I felt comfortable; usually after 2 to 3 blocks after which I would revert to random mode. During this time, I finished my FA 2018 for the first time (second read FA. First read was FA 2016).

I registered for the exam on Nov 29 2018 and choose my eligibility period as Dec 2018 to Feb 2019. My research was frustrating me and since I felt that I had already spent a lot of time studying, I thought that I should get the exam out of the way so that I could concentrate on my research from Jan 2019. School ended on December 11th and on December 12 2018, my dedicated study period began. I read FA 2018 cover to cover and my annotated notes coupled with B n B videos for the sections for which I felt I was still weak in from Dec 12 2018 till Jan 02 2019 when I finished. I would wake up everyday at 4:00 am and study until 5:00 or 6:00 pm with short breaks. My son would get home from school at 3:00pm and I would attend to him and then continue studying and use white noise to block out any noises he would make. After 5:00 or 6:00 pm, I would exercise for an hour. I am blessed that we have a treadmill in our basement and that is what I would use. I would run for 30 minutes or walk for an hour. Whenever I walked, I listened to/ watched my videos. Whenever I ran, I listened to Brick and Lace Station on Pandora. I could have finished reading FA earlier but I was unwell for a couple of days earlier in my 6 weeks dedicated study period and I had family visiting me; my sister and her 2 boys (3 and 6 years old) from December 30 2018 to Jan 2 2019 but I still managed to study for at least 5 hours a day during these times. By the time, I finished FA second read, I still had approximately 450 unused questions on my online UWORLD first pass. I did 0-3 blocks a day until I finished them on Jan 11 2019. After this, I started doing my in-corrects in random mode and then some blocks of only Behavioral, Pathology, Pharm, Biostat, and Genetics because these were my weak points in the online NBMEs that I was taking.

NBME 13 online score: 167 on Aug 07 2017.

Old NBMEs offline wrongs: 1=75 3=54 5=36; I did 2 and 4 too but I misplaced them and I don’t remember the scores.

NBME 15 online score: 211 on Dec 01 2018; six weeks before exam.

NBME 16 online score: 238 on Jan 04 2019; two weeks before exam.

UWORLD form 1 score: 243 on Jan 07 2019; eleven days before the exam

NBME 17 online score: 228 on Jan 10 2019; seven days before exam.

NBME 19 online score: 219 on Jan 14 2019; three days before exam.

Free 120 score: 83% on Jan 14 2019; three days before exam.

NBME 18 online score: 225 on Jan 15 2019 three days before exam.

UWORLD form 2 score: 245 on Jan 16 2019 two days before the exam

Real deal on Jan 18 2019: Score=243

Day before and Exam day:

On the day before the exam, I tried my best not to study but I couldn’t help it though I didn’t study as much. I still went out shopping for 2 hours and watched maybe 2 hours of TV to relax. On the day of the exam, I woke up at 4:00am. The plan was to wake up at 5:00 am but I couldn’t sleep anymore. I Skimmed over FA. I packed lots of snacks (the same snacks I was snacking on during my dedicated study period; apples, peanut butter, a flask of tea, roasted peanuts, chips and boiled eggs. A lot… I know). I dressed in pants and a shirt without pockets. This saved me a lot of time during checking-in after a break. I took my first break after the first 2 blocks and then a break after each block thereafter. I ate a snack before starting the exam and a snack during each of the first 2 breaks and after the 6th break. During the other breaks I only drank either tea or cold water . I washed my face with cold water from the water dispenser during each break. The cold tap water was not cold enough. The exam was really hard for me. At the beginning of my preparations, my aim was >240. After my practice exams, it reduced to 230. After my exam, I was praying to God for at least 220. I don't know how I got this score but I thank God!! Maybe my WTF questions were not counted.

What helped me:

1. Enrolling in the PhD program: In 2.5 years I was taught Microbiology, Biochemistry, Cell and Molecular Biology, Immunology, and Laboratory techniques, and Biostatistics. These became easier for me while I was studying for the exam. Biostatistics was also easier because of my MPH. There was an epidemiology question on the exam that I couldn’t have answered if I hadn’t learnt it during my MPH.

2. I made my own mnemonics as I was studying. Also, in the 3rd read of FA, I tried to memorize some of the FA mnemonics. I also used some Dirty USMLE mneumonics.

3. I studied at least 2 hours a day; 7 days a week for at least a year; even if it was just listening to lectures on my phone while I was driving. I don’t know how many times I did B n B and Pathoma videos. 

4. I watched Kaplan 2014 Pharmacology, Anatomy and Neuroanatomy twice. My basics in these subjects were really weak. 

5. I did all the online NBMEs. I did NBME 19 and free 120 on the same day in order to try and simulate exam conditions. I realized during these practice exams that I wasn’t going to save any time during each block for break and I prepared myself for this psychologically.

6. I did most of my UWORLD blocks in timed/tutor mode since I used UWORLD mainly as a learning tool. I realized that I would spend more time on each block if I did it in timed mode and then went back to review the questions. With timed/tutor mode, I would read the explanations there and then and not even review later if I made a silly mistake. I would mark and later only review those questions whose concepts I still didn’t understand even if I got it right on the exam. Remember, I only did this because I didn’t have a lot of time to study. If you do, do what you feel is right for you.

7. My husband is my number 1 supporter and encourager.

8. White noise when I needed to study but my husband and/or son were being too noisy.

What I wished I had done differently.

1. Concentrated on my PhD and finished first. Maybe I could have graduated last year in May and had a longer time to study for this exam. I really don’t know if it would have worked out that way though.

My advice to old IMGs who have the means and the time is to subscribe to online UWORLD ASAP and study your butt off. If not, use offline materials from this group. I found a lot here.

Why I think my NBME scores were all lower than my final score.

1. I made a lot of silly mistakes during my practice exams. In each exam, I accidentally chose the wrong answer at least twice (Like when you know that the correct answer is B and you intend to choose B but choose A or C instead accidentally.

2. I did 8 practice exams in 7 weeks in addition to reviewing and researching the wrong answer, doing UWORLD online, and reading FA and my notes. I always felt exhausted while doing these
exams. Most times when I was undecided between 2 answers, I would always choose the wrong one.