The Step 1 Examination: Preparation and Test-taking Strategies
By Ali Haider Jafry
I
was able to take the Step 1 exam on the 20th of September, 2017 in
my final year of medical school and managed to score 266, Alhamdulillah. Since
a lot of articles detailing the exam’s structure and test-takers’ experiences
already exist, here I shall only briefly outline my own experience and try to
highlight some of the more important ways in which I had to differ from other
students’ preparation strategies.
Resources:
Kaplan
Textbooks and Lectures: Anatomy, Physiology, Biochemistry, Pharmacology,
Microbiology, Immunology, Behavioral Sciences
Pathoma and Dr. Sattar’s Lectures
for Pathology
UWorld
Online
FirstAid
Conrad’s
100 Cases for Ethics
Step 2 CK
Psychiatry Offline
Biostatistics
UWorld Offline
Timeline:
I
made my decision to take the exam halfway through my 4th year in
medical school. In the same year, I took up the Kaplan textbooks for Anatomy,
Physiology and Biochemistry and studied from Pathoma for Pathology. Once I was
done with my final examinations for the year, I began with the rest of the
Kaplan textbooks in early March. It took me till the end of April, 2017 to get
done with the Kaplan textbooks and lectures once. I took a month to revise all
of the textbooks once, then took up FirstAid by the end of May, read it fairly
quickly (you don’t need to cram everything the first time around, just go
through it and revise what you already know) in about 12 days and then moved on
to UWorld. I did all of the blocks in the random
timed mode which, in my opinion, made all the difference in my preparation.
While doing UWorld, I did not resort to FirstAid (except to jot down the more
high-yield information from UWorld) for revision of topics or any other book
for that matter since it would have taken up too much of my time. By
mid-August, I was done with UWorld, had taken my date for the exam and
thereafter began my revision of FirstAid which was by now filled with all the
information I had transferred to it from UWorld. It was then that I also
studied the Biostatistics and Psychiatry Offline UWorld questions, which helped
me greatly in refining my performances in those two subjects. I then began
giving online assessments in quick succession (a test per day) from the 1st
of September as follows:
1.
NBME
13 online - 252
2.
NBME
15 online - 250
3.
UWSA
1 online - 273
4.
UWSA
2 online – 262
Here
I took a week to read my FirstAid for the third and final time before the exam.
During my final week, I gave the remainder of my self-assessment tests:
5.
NBME
16 online- 255
6.
NBME
17 online - 260
7.
NBME
18 online - 265
8.
NBME
19 online - 255
9.
NBME
12 and 7 offline
I
tried to not burden myself the day before the exam, bought some supplies for
the next day [fruit juices, canned coffee, paracetamol extra (contains
caffeine), chocolates, water etc.]. Take care not to heighten your anxiety by
using too much coffee and avoid amphetamines as well.
A
few important points:
·
Take
some time to decide why you want to go down the USMLE path. Discuss it with
your family and make sure you have a strong support system to turn to when
things are not going as planned. Do not take this exam lightly but don’t make
it out to be bigger than it is. It’s just a test in the end, like so many
others you’ve probably given before. Try to make a good routine for yourself
and don’t isolate yourself socially.
·
The
Kaplan textbooks and lectures are for building your basics only. Do not spend
too much time on them or annotate your Kaplan notes on FirstAid. Also, do not
start your preparation for the exam directly with FirstAid or UWorld unless
you’re sure your foundations are well-established. You may resort to any of a
number of good books for this initial phase but I would highly recommend the
Kaplan Biochemistry lectures by Dr. Turco and the Behavioral Sciences lectures
by Dr. Daugherty. The resources I’ve mentioned are more than enough so try not
to waste time on doing the subjects in great detail.
·
FirstAid
cannot be learned by heart, no matter
how hard you try. That is where UWorld comes in; the questions in UWorld will help
you know which information is high-yield and which isn’t. E.g. you can’t
possibly memorize all the side-effects of every drug, you usually only need one
or two.
·
Owing
to time restrictions, I was unable to begin my revision of UWorld and had to
restrict myself to only revising the questions I had gotten wrong on my first
go at it. However, I had a good score (81.5% correct) and percentile rank (90th),
so I considered myself ready for the exam.
·
A
lot of students tend to use UWorld as a learning tool only during their first
go at it, doing it system- or subject-wise. The Step 1 is not just a test of knowledge; more importantly, it tests your
ability to think critically and the best way to attain that is to use UWorld in
the random timed mode the very first time that you use it. This was part of the
reason why I scored well in spite of having gone through UWorld only once. I
would also recommend doing it online since it is a better judge of your
performance.
·
Try
and pace yourself for the exam while doing UWorld e.g. begin with a block per
day for the first week, 2 blocks at a time for the next 15-20 blocks, then 3
and so on. It’ll aid you greatly in pacing yourself for the real thing. Spread
out the days for reading the explanations as you see fit. Try and finish UWorld
within one and a half to two months. I think it’s quite manageable, since I was
taking my classes and wards at the same time and managed to do it within 2
months.
·
Revising
FirstAid 7-8 times will not do you any good. I believe that 4-5 reads of it are
more than enough. I actually felt I had begun to lose much of the information I
had amassed by the third read.
·
The
overall timeline for the exam should ideally not extend to much more than 6-8
months. The preparation itself is a drain on your body and spirit. Anxiety is
common in the weeks leading up to and the time after the exam as well. Keep this
in mind when outlining your timeline!
·
The
ideal time to give the exam would be within a month of revising UWorld. Do not postpone the exam date unless it is
absolutely necessary. I’ve seen many students delay their exams out of fear of
not being prepared for it or not scoring as good as they would’ve wanted on the
self-assessment exams. I do not believe it will do you much good; once you’re
done with UWorld twice and have given FirstAid 3-5 reads, you’re at your peak
in terms of knowledge and test performance. After that, the information just
gradually seeps out and if you’ve used up your NBMEs and UWSAs, you won’t have
a tool to judge yourself with.
·
As
you may see from my timeline, I was of the opinion that I would use my
self-assessment tests once I was sure my preparation had reached a peak and I
was ready to take the exam. Students do use the NBMEs and UWSAs to gauge
improvements in their performance but if you’re scoring well in UWorld, you
might as well hold on to the tests since they come in handy later on for
preparing you for the real thing.
·
For
me and quite a few of my colleagues, NBME 18 was most predictive of our actual
scores. The UWSAs are too generous while NBME 19 has a harsh curve. But don’t
get too stressed out over how to take these tests and in what sequence. Scoring
consistently is more important than scoring a 260 on one NBME and a 230 on the
next. As long as you’re getting consistently above the 240’s, you’re on track
for at least a 250 plus score!
·
Try
to book your date for the exam at least 2 months out. A lot of students are
unsure of the date they want and so they put it off, only to find out that
those dates aren’t available in the city of their choice. So try to book your
appointment early and then do your best to stick to it.
·
Try
to be discrete when preparing for the exam. I actively avoided study rooms in
my hostel and university and it helped me avoid much of the pressure that comes
with the expectations of people who know you’re preparing for the exam.
·
The
actual exam environment is really noisy since GRE test-takers are also usually
present. Be prepared for this by taking your self-assessment exams somewhere
that isn’t completely quiet. It’ll help you immensely during the exam.
On the
Day of the Exam:
·
Print
out 3-4 copies of the scheduling permit a week or more in advance to be on the
safe side, have your passport made since it is required for the exam and
remember to take your ID card with you as well.
·
Wear
comfortable clothes with as little pockets in them as possible since it’ll help
you with the check-in process during the exam. Also take a jacket or sweater
with you in case it gets too cold for you.
·
Arrive
at the test-center early and plan your commute beforehand, taking any
roadblocks, protests etc. into account. You should receive a call from the test
center as well in the days leading up to the exam confirming your appointment
and the time you should arrive at the center.
·
Beginning
at least a month before the exam, try to go to bed early, getting a good 8
hours of sleep. It is perhaps the most important step you can take to ensure
performing well on the day of your exam. On the night of the exam, an
over-the-counter sleeping pill (antihistamine) may come in handy, as may
hypnotics such as Zolpidem but try to avoid benzodiazepines if you can.
·
Read
the questions very thoroughly, decipher what concept the question is testing
you on and try to come to a conclusion about the answer, if it’s possible,
before even reading the answer choices. This will help you avoid ambiguity about
the correct answer. For lengthy question stems, it helps to read the last line
first.
·
There
are always hints and clues in the
question stems, sometimes as small as a single word. You need to accustom
yourself to catching these on UWorld and NBMEs.
·
Choose
the very first option that comes to mind for answering your questions. It is
the right choice for most test-takers. Orient yourself to always think that
your first hunch is the correct one and then if you suspect it may be wrong,
give yourself solid reasons to change your answer.
·
Be
prepared to face about 5-8 or even more questions on each block that may seem
to be really hard to answer. Reason your way through them as best you can, make
educated guesses and move on. There are usually small clues in the question
stem that you may miss out on in the first read. So mark the questions and read
the stem again at the end of the block if you have time.
·
Depending
on the test’s difficulty, you may find yourself with ample time at the end of
each block or you may not find enough time to completely go through all the
questions thoroughly. For me it was the latter, even though I would always have
a good 10-15 minutes left at the end of each block in UWorld and the NBMEs. Do
not be fazed if this happens; instead, think that if the exam is tough, you
have a better chance of scoring higher on it!
·
You
may take your break time as you deem fit, based on your experience from UWorld
and NBMEs. I took ten minute breaks at the end of each block, taking a sip of
coffee and eating some chocolate every time I did so. This strategy helped me
regain focus for the next block, recharge myself and rest my eyes for a while.
·
Everyone
makes simple mistakes on the exam. Do not beat yourself up over it; just brush
it off and move on to the next block.
·
Lastly,
aim for a good score but keep your expectations reasonable!
Once
you’ve given the exam, relax and take solace in the fact that you’ve given one
of the most competitive exams in all of medicine. You’ll receive your score
exactly three weeks later. I believe it’s important to state here that every
student has his/her own way of going about preparing for the test, so this
article is in no way meant to dictate how you should study; it is only to help
guide you on your way. I wish you the very best for this journey!
Ali Haider
Jafry
King
Edward Medical University, Lahore
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