Hi, Im a fourth-year student at the University of Queensland in Australia.

I sat the
USMLE Step1 on the 14th of December, 2012, and I would like to share my
experience with those whom may find it helpful.
I had not planned on nor had I ever considered sitting the USMLE until I had almost
finished MS2, so my focus became that of taking the exam at the end of my thirdyear (first PhD year). I thought the prep would be relatively simple. It wasnt. The
Australian curriculum places very little emphasis on the basic sciences, and I had to
learn the vast majority of the material from scratch. This is mostly with respect to
embryology, microbiology, immunology and pharmacology, as well as biostatistics.
Biochemistry was also not covered at UQ, but fortunately my undergrad major was
in the subject, so it never became an issue for me.
-----------------------------------------------For the sake of clarity, the Australian academic year is the same as the calendar
year, so classes run January-November, not August-June.
Pre-preparation phase:
During my MS2 (2011), I spent the first semester (Jan-May) reading big Robbins.
This is practically all that I did. I spent probably 4-6 hours per day going through
this book. Once again, this is before I had ever planned on sitting the exam, and
truthfully, I wouldnt recommend going through this book either. It contains a ton of
information and is unquestionably one of the gold standard resources out there for
path, but its not presented in a way that is even remotely concise enough for
effective USMLE prep. That is let alone the fact that the majority of the text is lowyield. Use this tome as a mere reference.
In June of my MS2, I had come in contact with a student at my school whom had
played a transformational role in my learning. He began to mention some of the
resources he had found to be helpful. I purchased BRS Pathology, and after having
read a chapter of it, immediately jettisoned the Robbins method. BRS Path is super
well-consolidated and presents the major ideas as high-yield bullet points. I found
this organization to be better catered to my learning-style because I was able to
simply memorize the chapters with alacrity as opposed to having to filter through
much of the low-yield info in Robbins. Per the same number of hours spent
studying thereafter, my efficiency with regard to learning high-yield information had
been improved significantly.
During semester-two, I would review a chapter in BRS Pathology on the Sunday or
Monday before that corresponding topic was discussed in PBL on Tuesday. This way,
I entered the week already having had a pretty good summary of the major ideas as
opposed to having merely seen them for the first time in PBL. This helped me
facilitate the class discussions. On Wednesdays, I would continue reading BRS Path
and memorizing it the best that I could. It took me a very long time to go through

the chapters because I generally made sure I could reproduce them by memory
repeatedly before moving on.
On Thursdays, I had pathology prac at the hospital, so I would spend the preceding
1-1.5 hours in the specimen lounge reading DejaReview USMLE Step1. This was a
great top-up to BRS. This book has a Q&A-type format. I would go through the
corresponding topic that we were covering that week, so I would enter prac already
having read BRS and DejaReview. This once again helped me to participate. The
active involvement served as positive-reinforcement, so this BRS-DejaReview
method during the early-mid-week worked quite well for me.
The catch is that the pathologists lecturing the pracs almost always developed their
Powerpoints directly from Robbins. So the fact that I was no longer perusing big
Robbins was beneficial because instead of having to go through the text myself to
extract the main ideas, I let the prac tutors do the dirty work for me. In other
words, their Powerpoints essentially became my Robbins summaries, thereby
further obviating the need for me to reference that text. So by late-Thursday, I had
also covered Robbins.
I then spent Fridays and Saturdays going through topic-specific questions on
University of Utah Webpath and in Robbins Review of Pathology. Whichever
questions I had not managed to complete at the end of a given week I always made
sure to finish before SoM exams. These questions, particularly the Webpath ones, in
combination with my change in resource-use, improved my grades dramatically. I
even recall a frenetic post-exam debate people had had on our SoM forum about an
ambiguous question, but I had seen an almost identical question on Webpath while
studying just days earlier. I cannot advocate more the value of Webpath. Use this
resource.
Once Saturday passed and Sunday arrived, I did not touch material from the
previous week. Sundays always equated to getting a jump start on the next week.
If I had felt at any point that I had needed to continue looking at stuff from the
previous week too late. Sundays were strictly for preparing for the next week.
Period. Staying one step ahead is extremely important during MS2. Its never
harmful to review previous weeks material from time to time, but going into each
new week with foundation will not only positively reinforce your comfort with and
command over MS2 material, but it will also give you the ability to be a more
helpful, influential and impactful colleague.
During the neuro weeks of MS2, I had also gone through HY Neuroanatomy SECOND
edition. I emphasize that I used the second edition because, several months later, I
had coincidentally looked at the 5th edition that one of my friends had for
comparison, and I found that although the latter was much more presentable and
overall more informing, it was also much less concise. My impression was that the
5th edition would be great for someone in MS1 who wants to learn a broader

foundation in neuro, but that the 2nd edition was still better for USMLE prep.
Resources may become more affable with time, but that doesnt mean they always
better serve their purpose.
When I approached the end of MS2, I decided that it wouldnt be unwise to keep my
options open for the future, so I began preparing for the USMLE.
Preparation phase:
In late-2011, although I had several friends whom had been preparing for the
USMLE during MS1/2 and were sitting it in a few weeks time, I was still yet to have
seen First Aid. I knew I was in no position to take the exam any time soon. I began
by purchasing the Sanjiv Microcards and Underground Clinical Vignettes Anatomy.
I went through both of these resources haphazardly during December 2011 and
January 2012, but had finished both by the end of January 2012. I also started
listening to the Goljan audios. I only went through about two-thirds of them
because I was impatient and only found them to be moderately helpful (I should
make note, however, that this was only because my pathology was already pretty
good by the time I finished MS2; had I started listening to Goljan a year earlier, I
definitely would have found him to be phenomenal. I highly recommend the Goljan
audios during MS2.). In addition, I bought the Lange pharm cards. I only went
through about 20 or so of these at this point in time, then put them aside.
Mid-January 2012, my sister had purchased for me a till you pass subscription to
USMLE Rx QBank. I did 100 questions in tutor-mode and got 67 correct. I noticed
that alongside the explanations there were also PrntScr images of pages from FA,
and that the vast majority of the questions I was getting wrong had answers straight
from the text. I realized that I was better off first reading FA and then tackling the
QBank for reinforcement, as opposed to blindly doing questions first. So I
purchased FA2012. In retrospect, I believe I was probably sitting around a 190-200
had I sat the USMLE at this point. Although 65% is about the average in Rx (which
means one could arguably say a 220 was possible for me), this figure is left-shifted
figure because most people who utilize Rx do so early, rather than late, in their prep
(so this is an average among less prepared test-takers).
I spent three weeks during February at 8-12 hrs/day reading First Aid cover-to-cover.
There was such a large volume of info that I swore I was forgetting most of it, but I
continued on. The day after I finished FA (in late-February), I recommenced USMLE
Rx. I noticed immediately a dramatic difference and was averaging around 85-90%
on blocks, in contrast to the 67% I had mustered before having touched FA. I spent
8-10 hrs/day during March and April laboring through Rx at a mere 48 questions/day
in random, tutor-mode. I annotated everything I found important into FA. This snail
pace was due to the fact that I had not seen most of the material before. But on the
other hand, I was inadvertently learning a lot.

By the time I finished Rx, I could tell that my grasp of the material had changed
drastically. I believe at this point I was probably sitting around a high-230, or just
nicking 240, if I was lucky. I spent the month of May going through BRS Behavioral
Science at a chapter per day. I read each one in the morning before starting my
real studying. This method made the read very manageable. I had started this
book because behavioral was my worst subject in Rx, so I had had to remediate
somehow. During the day-time, I went through FA Q&A and Kaplan QBook. I did not
annotate my FA from these resources, and I read only the explanations from Kaplan
QBook. This was mostly because FA Q&A was very easy, but Kaplan QBook still
assessed quite a few details I had not encountered before. I then took a solid ten
days toward the end of the month as a vacation roadtripping/backpacking up to
Cairns and the Great Barrier Reef for scubadiving (highly recommend this if you
ever trek down under). Because I had been traveling with my good friend, who is
also a med student, he happened to have had a copy of Underground Clinical
Vignettes Behavioral Science lying on the floor of his car. So during down-time, I
blasted through this book.
I should also mention that for the first half of the year, whenever I had gone
anywhere via public transportation, I would randomly read either First Aid CASES or
Step1 SECRETS. I finished CASES but only read about one-tenth of SECRETS (see
my reviews at the end of this post).
June and July were more turbulent and desultory study months because I was
travelling a lot and had had family obligations. I spent the first ten days or so of
June initiating my second cover-to-cover pass of FA. I then curtailed this effort and
looked into Gunner Training because some people had raved about it. I did not like
the flashcard system (personal preference, although some people love it), so I
instead just did their QBank. I went through it at around 150-200 questions per day,
annotating into my FA here and there, but not religiously. By the first week of July, I
had finished GT QBank. I then went through HY Cell & Molecular Bio, and then
recommenced my second cover-to-cover pass of FA from where I had left off
previously. I finished FA again by late-July. My second pass of FA took about the
same amount of time as my first pass had. The difference was that the second pass
included the need to review annotations, so I was probably covering ~20% more
text in the same amount of time. Even still, it was quite a slow pace. I also blasted
through the Lange pharm cards and Brenner cards. In January, it had taken me
several hours to go through just 20-25 cards. However now, I went through all of
the Lange + Brenner cards in just two days. The Brenner had some lower-yield
drugs, so I wrote the ones I hadnt heard of before on post-it notes and put them on
my desk. I would Wiki a random drug every other day or so. By the time I sat the
exam, I knew the drugs in FA + Lange cold + a handful of the lower-yield ones in the
Brenner stack.
I then sat NBME-3 online late-July (they retired this exam on July 30th, 2012) and
scored 250. I spent two days flipping through random questions from the

behavioral and pharm Kaplan lecture notes and then started Kaplan QBank the first
day of August. I went through Kaplan QBank at 6-8 hrs / 100 questions / day in
random timed-mode. The 150-question diagnostic + 2200 QBank + two full-length
exams = ~3000 questions. I got through everything in just one month. I annotated
Kaplan into my FA in orange ink. So at this point, blue/black annotations were
mostly USMLE Rx and GT QBank, and orange was Kaplan.
The first day of September I started UWorld. I thought because I had been able to
go through Kaplan so quickly that my UWorld pacing would be comparable. Wrong.
I found UWorld to be incredibly info-dense, and I progressed at a similar speed as I
had with USMLE Rx: 6-8 hrs / 50 questions / day. Whereas with Rx I had done one
48-question block per day, since UWorld only allowed a maximum of 46 questions
per block, I did two 25-question blocks per day. I went through my first two blocks
of UWorld in tutor-mode to get accustomed to the interface, but then did the rest of
the QBank in random timed-mode. I finished UWorld by mid-October and had made
all of my annotations into FA in green ink.
I went on to do all of the offline NBME exams (1, 2, 4 [please dont ask me for these
because I dont have them; if you want them, make a thread asking where to find
them and someone will PM you]) and some other random question sources, such as
Microcards QBank (~75 questions) and UWorld biostats PDF (~75 questions). I then
sat NBME-5 online late-October and scored 257. I was surprised that I had done a
significant amount of work since late-July and had only increased seven points on
the NBME. I began to realize that my progress, if graphed, likely resembled the HbO2 dissociation curve. I was aware that prepping beyond this point wasnt
necessarily going to buy me additional points as much as it was just building my
confidence and comfort in being able to achieve a [I]minimum[/I] score. In other
words, I knew putting in additional months of study ultimately wasnt going to
guarantee me a super-high score as much as it was merely safe-guarding me from a
low outcome if the random allotment of questions on my real USMLE turned out to
be unfavorable. I would say once you realize youre entering your plateau phase,
youre building potential, rather than kinetic, energy. It will make you slightly
dubious as to your methods, but its completely normal. You just need to continue
pushing onward.
After I sat that NBME in late-October, I went through the USMLE Rx for the second
time. I did about 5-600 questions before realizing that they were far too easy
compared to the ones in UWorld. While they were great during my early prep, this
late in the game, I knew it was better to focus on other things (however, if you are
late in your prep and havent done Rx, I would still recommend it; one pass was
good, but not two. Regardless as to how easy the questions are, there was still
some stuff that showed up on my real USMLE that I had only encountered through
Rxs explanations).

So after those 5-600 questions, I began my third cover-to-cover pass of FA. This
time, I had needed to read not only the text itself, but also all of my annotations
from the past half-year. I had (with no exaggeration) probably doubled the length of
my FA. I [I]still [/I]went through at roughly the same pace as I had the first two
passes. But because the length of text had been augmented considerably, I was
actually reading pretty fast. In contrast to the first two passes, however, for the
third one, anything that was not already 100% engrained in my memory I wrote
down in a separate notebook. I filled up about half a small notebook with my tiny
handwriting. I dated each days notes and, before beginning my reading for that
particular day, reviewed for about 30 minutes what I had written the previous day.
This was an incredibly fastidious and menacing process, but I just dealt with it.
I finished the third cover-to-cover pass by mid-late-November. I then began going
through UWorld for the second time at 322 questions per day. I did this in tutormode but, for the most part, breezed through it and only superficially reviewed
tidbits of info when needed. Anything I had gotten incorrect or had marked this
second time around I made sure I reinforced doubly. The benefit of having gone
through UWorld in its entirety for the second time was for helping to build rapid
recall skills.
I finished the second pass of UWorld by the start of December (two weeks-out). I
then flew from Australia to New York. I was extremely jetlagged, but decided to sit
NBMEs 6+7 anyway as an experiment to see how I could manage testing conditions
while tired. Well, all I have to say is: get your sleep. It makes a huge difference.
NBME6: 252 (12 days-out)
NBME7: 254 (11 days-out)
I freaked out after these results. I didnt know why they were worse than my NBME5
result, and I questioned whether I had been doing something critically wrong. Either
way, I was too close to the exam to ruminate over technicalities, so I just tried to
maintain my composure the best that I could.
I spent the next day going through FA at random and looking through old NBME
questions (I should mention that I had made a Powerpoint file with PrntScr images of
all of my incorrect NBME questions). I then sat free-150 (10 days-out) and got 95%.
MedFriends predicted this to be 270 +/- 11. I had said in a previous post that I got
268 +/- 11 on Free-150, but it was actually the former that was correct (not that this
matters or is even remotely important, but I thought Id clarify for the sake of
anyone who types 95 on the MedFriends website and notes the inconsistency).
I spent the 9th day-out reviewing just biochemistry from FA.
NBME13: 264 (8 days-out)

I spent the 7th day-out reviewing just embryology from FA (and other random
things).
NBME12: 266 (6 days-out)
I spent the 5th day-out reviewing just microbiology from FA.
NBME11: 264 (4 days-out)
The third to last day was just pharmacology from FA (end of each chapter and the
pharm chapter itself).
The last two days I did practically nothing. In actuality, I spent probably a total of
two hours on the second to last day looking at my Powerpoint of incorrect NBME
questions, and the final day I quickly touched up on neuroanatomy using the neuro
only sections of the Kaplan anatomy lecture notes. I didnt read them. I just looked
at the images. I didnt do anything else those last two days. To that effect, I believe
I had spent more time during the final days watching Alex Honnold rockclimbing
videos and writing poetry than I had actually studying.
All of my study days during the final two weeks were at ~50% effort relative to
those throughout the year. I felt fairly prepared, and by having done the NBMEs, I
knew that trying to get a score mid-260s+ was primarily bound to getting lucky with
minutiae. What separated my NBME6+7 performances from NBMEs11-13 in just a
matter of days had absolutely nothing to do with reading FA and everything to do
with sleeping more (i.e. not making stupid errors) and getting minutiae questions
that I coincidentally knew. There was nothing else to it. That was it. If there had
been some arcane secret to the success-equation other than that, I would have
assiduously appropriated 12-15 hours/day during those final two weeks optimizing
to ensure that 270. However, the best thing I could do was just to stay rested and
not feel beleaguered.
Backtracking, I did recognize, however, that my reduced study effort during the final
weeks was largely incongruous with my drive to do well on the exam. I had
encountered some form of impasse. I felt bemused, dissonant, burned out. That
was it: I had burned out.
This started roughly 5-6 weeks from my test date at the beginning of November. In
a panic, I had sent several PMs to my friends on SDN asking for advice. They all told
me to take a little time off. Take time off? This close to the exam? Are you crazy?
But I did. Reluctantly. I spent an entire day up at the beach with some mates. It
was exactly what I had needed.
Everyone who encounters a burnout manages and experiences it differently. You
reach this point when your rate of growth of learning, although always positive, has
begun to decline to the point that studying the material no longer produces
identifiable gains. This is not to be confused with apathy or mere lack of

motivation. This is an honest realization. It means that youve genuinely learned

the material sufficiently such that theres no longer any drive to reinforce it. It
means youve finished all of the resources that you had been striving to grow from.
Early in my prep, I had envisioned that I would be sprinting toward the finish line
doing 15-hr days in the weeks leading up to the exam. In contrast, I surprisingly felt
a temporary perturbation and lack of motivation starting about 5-6 weeks-out.
I sat back and thought hard about what was going on. This was no time to lose
motivation, so I needed to objectify the scenario and come to a solution. I realized
that my motivation hadnt ebbed. It was merely that my growth rate had declined
and I was no longer stimulated. This was the defining moment of my USMLE
preparation. It meant that I had in fact been studying for intrinsic reasons all along.
As much as I may have felt inclined to abnegate my freedom on the basis that I
wanted a strong score, I knew that if the score itself had been the only impetus,
then I wouldnt have experienced any perturbation. I hadnt suddenly lost
motivation. I had merely become subconsciously aware that I was no longer able to
reinforce the material more than I already had.
[B]Therefore, ones false perception of a decline in self-motivation late in prep is
reflective of having mastered the material, and is in turn an integral and necessary
stage of study-optimization.[/B]
One should always remain impassioned up until the actual exam, but if he or she is
still driven and ignited by the material itself through to the very last day, then he or
she has not yet peaked, and therefore has not yet reached his or her fullest
potential. The very definition of peaking is manifested by a loss of interest not
one of premature apathy or as a form of repression, but instead one as a byproduct
of honest progress and sense of completion. Tapering your studies when
approaching the exam shouldnt be a conscious decision. It just should happen.
The real solution I developed to avert the burnout, apart from merely taking that
beach day, was more importantly through action, not just thought. I made it an
obligation to have a mere physical presence in the library for at least eight hours
per day. During the month of November, I was nocturnal. I slept from 2-10pm, went
to the gym from 10:30-11:30pm and then went to the library from about midnight
till 8 or 9am. I would then skate to one of the local cafes, grab a quick breakfast
and then head off to bed. Had I not held myself to going to the library inveterately
during this month, it would have been extremely difficult for me to have finished
that final pass of FA. It was grueling. But this is where it all culminated.
The night before the exam, I stomached a meager dinner of two protein bars and a
slice of pizza. I watched Shawshank Redemption on DVD, drank two cups of
chamomile tea with milk and honey, read a little from a new novel I was starting,
reflected on the past year and then went to bed. I got 8.5 hours of sleep. And then
I finally sat the US medical licensing exam on the 14th of December.

Exam experience:
I purposely scheduled my test for a 12:30 8:30pm timeslot. I am not a morning
person nor have I ever been. I was glad I had been able to sleep well the night
before. I started the day with the normal routine, and I had a bowl of SmartStart
cereal with skim milk and three-quarters of a banana. To get my mind functioning, I
made sure to carry a conversation with my dad while he was driving me to the
testing centre. I would not recommend reviewing any material or doing warm-up
questions the morning of. It will only add to any latent anxiety. Youve prepared
well for this exam, remember? Trust what you know. Be confident in yourself.
I was the first to arrive at the testing centre. I recommend getting there a full hour
early. There will be a maelstrom of people waiting to check in, so the earlier you get
there, the less you need to dither. I made perfunctory chat with other students
before the test, but once everything got underway, I entered my own zone and
didnt talk to nor look at anyone for the rest of the day.
Before you start the exam, the proctors will take your picture, fingerprint you,
perform a signature test alongside your passport, search your pockets and send you
through a metal detector. Every time you take a break and walk into or out of the
testing room, these security procedures are repeated in front of a camera. There
was greater security at my exam than there was each time Ive vacationed to and
from Israel. You will also receive two laminated sheets of paper and two fine-tip
markers. Crossing out is allowed, but erasing is not. If you run out of space (you
wont), they will give you additional materials.
Bring your own foam earplugs. Your testing centre should supply them, but bring
them just in case. At my computer console, there was a pair of those orange
helicopter attendant-type noise-cancelling earmuffs as well as a pair of black
headphones that were plugged into the computer. During the exam, I had my foam
earplugs in and the orange earmuffs on. I had only encountered two heart sound
questions on my exam, so for these, I removed the foam earplugs and orange
earmuffs, switched to the black headphones momentarily, then upon finishing the
questions, put the former back on. The earplugs + black headphone combination
didnt block out as much sound, which is why I cumbersomely dealt with the switch
mid-exam.
At the start of the test, they had assigned me a cubical location toward the front of
the testing room. I didnt like this spot because the computer screen was in
everyones plain view, so I asked to be moved to a more private space in the back.
They acquiesced. This is yet another reason why I recommend getting to the
testing centre early. You never know what inconveniences might arise.
Upon registration, you will receive an examinee ID#. You must write this on each
laminated sheet of paper as well as enter it into the computer to commence each
block. In other words, you will enter this number into the computer seven times on

test day. A picture of your face will appear on the monitor in front of you, and youll
enter the number in the space below the photo. I mention this because some
people have asked whether one could accidentally resume someone elses exam or
if a timer magically starts once you enter the testing room. The process is tightly
regulated, so no accidents will happen. Dont worry.
When I first sat down at the console to start the exam, the intensity of the moment
was [I]profound[/I]. The first question loaded, and it was surreal that after all of
those thousands of practice questions I had done after all of those thousands of
pages I had read after all of those long hours and sunrises through the library
windows I was now actually engaged in the real deal. My heart was pounding
vehemently in my chest for the first seven questions or so. My stroke volume was
off the charts. I was thankful that the exam started off easy because I was able to
build momentum quickly. Had I needed to deal with some recondite ethics or
graphing question right off the bat, I may have gone into cardiac arrest. But as the
ball got rolling, I actually got excited. Never had I worked so hard for something
before. I was pumped.
I did the first two blocks back-to-back with no break (took 60 seconds sitting at my
desk without leaving the testing room). After the second and third blocks, I had half
a protein bar and a few sips of water. After the fourth and fifth blocks, I had a diet
Redbull and half a PBJ sandwich. After the sixth block, I chugged the third diet
Redbull but consumed no calories. I also made sure to micturate each break.
I used almost all of my break time on exam day. Although I had finished each block
with 10-25 minutes to spare (this time is added onto your break time if you end a
block early), I used every examination minute I had to review both marked AND
unmarked questions. I had had a habit of making careless errors on the NBME
exams, so I tried my hardest to minimize these. That being said, if you have any
extra time at the end of your breaks, I exhort double-checking your work. This
doesnt mean you should start psychoanalyzing or overthinking questions. If youve
done lots of practice questions, youll know how to use your time to your advantage.
But regardless, definitely use it, and at the very least, just to make sure you didnt
accidentally click transformation on a question when you meant to click
transposition. This stuff happens, no matter how composed you think youll be on
exam day.
For a bit more clarity, Ill give general breakdowns for each subject as far as what
showed up on my exam. But be aware that everyones form is different. Whereas
some people might have lots of micro and very little anatomy, for instance, others
might have it the other way around. So the following isnt what would necessarily
appear on your exam. Its just an example of what is possible.
Anatomy (10-15 Qs): several questions on upper limb nerves; one question that
relied on you knowing the image of the brachial plexus very well; a question on the

vagina; a question on urinary incontinence; one abstruse abdominal X-ray with

frontal and lateral views; one question involving a muscle insertion point; a very
strange question involving a thoracic stab wound, where they wanted to know which
structure was compressed, but the structure (as inferred from the patients
presentation) wasnt immediately in the region of the penetration; simple lymph
drainage question; question on histology of respiratory tract mucosa in a specific
location.
Embryology (5): aortic arch derivative; some questions on pharyngeal
clefts/arches/pouches.
Biochemistry (20-25): this is where some of the trickier questions were on my exam.
They werent necessarily difficult at the core of what they were asking, but they
required that you knew your metabolic pathways very well and then were able to
manipulate them. Know anabolic/catabolic enzymes and how they relate to cAMP
and phosphate group shuttling. Know your terminology (e.g. difference between
phosphatase, phosphorylase, etc.). In turn, know how substrate concentrations will
change upstream or downstream depending on alterations in a metabolic pathway.
Understand your G-protein pathways and lac operon and be attuned to how
mutations (whether inactivating or constitutive) would produce a deviation; or
conversely, be able to infer where a mutation would have occurred based on any
information they give you. I had a question late in my exam that involved two
different types of mutations in a single common pathway; pathways on their own
are easily memorized, but youve got to study them well enough so that youre able
to flip things around, even when youre tired. I also had a one-liner question asking
something very specific about an intracellular protein; another tricky question on
glycogen enzyme regulation; an easy question on a glycogen storage disease;
another one-liner minutia question asking about ion channel regulation in a specific
tissue; question on gluconeogenesis where you needed to know what happens in
the mitochondria vs cytosol; another specific question on what would occur in a
pathway based on a particular change in diet; two questions on intracellular
signaling molecules (know how proteins are shuttled around and modified); easy
question on insulin and C-peptide; ultra-specific question making sure you could
identify and differentiate between the familial dyslipidaemias; two questions on
collagen; couple of pedigree questions; some questions on CF and AIDS
mechanisms; tough question on a vitamin in a patient with an atypical presentation.
I also had a ridiculous question on ELISA that was by far the most WTF question I
have ever seen. I encountered it in the 6th block, read it for 60 seconds, didnt click
an answer, then went back to it and spent an additional 7-8 minutes answering it. I
had read on the scores thread from 2012 where a couple people had mentioned
having encountered a WTF ELISA question. Well, Im not sure if what comes around
goes around, but this one did come for sure. The 6th block was the only one that I
didnt have enough time to double-check of all of my unmarked questions. And it
was strictly because of that one ELISA question.

Biostats (10): a few simple questions on sensitivity/specificity; a question about

understanding what alpha, beta and power mean; a question on population data
interpretable from a graph. I also had a WTF question that involved a simple graph.
It should have been incredibly easy, but I had no idea what they were asking
because the grammar didnt make any sense. I spent a solid three minutes at the
end of the block just trying to figure out how the meaning of the graph changed
based on where the commas should have been in the question. This was in the first
block too, so I was preter-awake. There was no catch. It was just a poorly written
question. I still have no idea whether I got it right.
Behavioral science (15): a couple of questions on developmental milestones. One
asked about a reflex; the other wanted you to interpret, based on the vignette,
whether the motor, cognitive and social milestones had been met by an infant. One
question on sleep. Know what happens during each stage of the sleep cycle. They
tried to be tricky with this question, so also know how to differentiate between the
different sleep disorders. A question about mental retardation in a developmental
disorder. Several (probably 6 or 7) ethics questions. Two were tricky. One asked
about a situation I never could have prepared for. It involved working with the
parents to develop a management plan for a child with a particular disorder.
Microbiology (15-20): a couple questions asking the structural characteristics of
viruses; a couple easy ones giving classic presentations and then asking for the
organism; a very difficult one on tropical disease; three very hard image questions,
two of which asked about organisms that arent even in FA, and on top of that, one
of these asked about the treatment, where the correct answer was a drug I had
never heard of before. Another very tricky question on bacterial toxins (know how
these relate to immunology); three questions on vaccines; question on pneumonia;
question on meningitis. Overall, micro was my best subject going into the exam,
and I walked out having felt like it was the hardest topic I had encountered.
Immunology (15): question on bacterial toxin and three on vaccines (same as those
mentioned in micro up above); at least 6 or 7 questions on immune responses in
tissue reactions (know the cells involved for all of the major immunological reactions
and hypersensitivities) ; I even remember thinking during the exam that if I had
been shaky on which cells were involved when/where, I would have been screwed; a
question on viral propagation/proliferation; couple of questions on congenital
disorders listed in FA; question on immunoglobulins.
Pharmacology (15): about half were simple pharmacokinetics questions; hard one
on drug toxicity; tricky one on a low-yield side-effect of a drug; very difficult
question regarding the identification of an ultra-low-yield organism via an image
and then knowing the Tx was the obscure drug listed (as mentioned in micro
above); a couple neuro-related; a couple on anti-psychotics and anti-depressants;
one low-yield anti-cancer agent MOA.

Pathology: tough to give a number here because path overlaps with pretty much
everything, but it was the majority of my test. I had many gross images,
illustrations, several MRIs and X-rays, and even some on organism identification.
Overall, I had neuro-heavy exam and relatively little respiratory or repro. The
USMLE is primarily an examination of pathology. This requires an integrated
understanding of a broad scope of it in conjunction with patient presentations. You
can be a rare guru at a subject like anatomy or micro, for instance, and still only do
okay on the USMLE. However, if you know your path inside and out, youre going to
do very well. Just think: Goljan would rock the USMLE and he wouldnt even need to
refresh his basic sciences.
Physiology (20): mostly arrow questions; two of them were extremely difficult,
where one was with regard to a disease that was low-yield and not even in FA.
Basically, the first one took a rare disease and then wanted to know very specific
things about it in arrow-form. I couldnt believe they were so pedantic about
something so rare. Ive always been one to obsess over small details, but even I
found this question pedantic. For hypothetical purposes (i.e. this is NOT what
actually showed up), it would be like them asking about changes in biotin and
succinyl-CoA utilization in hypokalaemic periodic paralysis. Yes, it was that
retarded. The other question wasnt about a too uncommon disease, but one of the
variables was just exceedingly odd. Once again, for hypothetical purposes, it would
be like them mentioning fructose intolerance (so far so good), but then, as the fifth
arrow-variable, they want to know about the change in cytidine concentration in the
kidney. Just odd. These werent things I believe any of us could prepare for. I also
had one question on ion channel regulation; one very tricky question on cardiac
function represented in a strangely graphed form, where you had to infer, based on
the graph, the mechanism of the drug used; one renal calculation question; one
tricky question on pressure vs resistance in graph form, where they were comparing
different vascular locations, and you had to keep a lot in your short-term memory to
answer it correctly. Id say a few of the pure IQ questions that appeared on my
exam relied on you knowing your physical sciences really well and then being able
to visualize information in a recondite way. Physio was definitely one of the more
challenging subject areas I had encountered.
Molecular biology (6): had six pure mo bio questions that I can think of off the top of
my head (i.e. not integrated with biochem or path, just pure lab technique-type
questions). Had two tied into bacterial nucleic acid acquisition; question on
modification of viral phenotype in vitro; question on gene transfer techniques; two
questions related to plasmid construction, where one was pretty hard and I
narrowed it down to two choices. I answered this one via trying to integrate my
external knowledge, but I couldnt have ever prepared for it. What made it difficult
was that you needed to know very specific functions of each individual plasmid
component within the context of an experimental model. I believe Kaplan QBank

helped me most for the mo bio questions because they were fairly OCD about this
subject.
During the 6th and 7th blocks (particularly the 7th) of the exam, my mentality and
strategy had changed. As rested as I had been going in, and despite having had
three diet Redbulls, my sensorium began to feel increasingly clouded. It felt like I
had been awake two nights in a row and was still forcing myself to operate at 110%
capacity. Whereas at the beginning of the exam, I worked through each question
meticulously and judiciously, by the end of the exam, my subconscious mind had
taken over and I pretty much answered everything on rapid recall. Some of the
questions would load, I would look at them for 4-5 seconds as though they were
some sort of wordless collage, instantly click an answer, then go back and spend
another half-minute reading, only to keep the same answer. I had felt most tired
on this last block, but I had finished it faster than the previous six, with almost half
an hour left. The whole thing was a blur.
When I walked out of the testing centre, I was certain that I had done very well on
the exam. I was aware that I had broken 260, but I wasnt sure as to the exact
margin. However, as the days rolled by, I became cognizant of at least five
absolutely careless errors I had made, and I had to come to terms with the reality
that a 270 was just no longer a possibility. Its like submitting a cover letter for a job
you really want, only to realize after the fact that you spelled something wrong. It
was just too late. Based on the NBME exams, a few questions translate into a
dramatic difference in score once in the 260+ range. If you want that 270, being
well-prepared isnt enough. You need to get lucky on the handful of minutiae
questions, you cant make errors and you need to be tremendously gifted. All three
are prerequisites. I was able to achieve a 262 on the USMLE Step1.
Im generally content with this outcome. Not ecstatic. Not disconsolate. Generally
content.
If the exam had been a chess game, I feel it ended in a draw. I read all of the books.
I knew all of the openers. I had sufficient end-strategy. But the game still ended in
a draw. Ill accept the handshake.
-----------------------------------------------Now let me just make something clear about the resources Ive mentioned above:
those were the heart of my prep. I am a book buff, and purchased pretty much
every resource out there for USMLE Step1 prep, and I had looked at over 50
different texts throughout 2012, but most of them did not ultimately help me in any
way. If they didnt help me get additional questions correct in UWorld, the NBMEs or
on the real deal, I didnt list them above.

Resources I do NOT recommend:

Brenner pharmacology cards contain more drugs than even the Lange cards, but
unlike the latter, they are not vignette-style and extremely monotonous and boring
to learn. More importantly though, the information given on the description side of
the cards is either too vague or specific for USMLE prep. For the USMLE, you need
to know key words/phrases (e.g. macrolides inhibit the translocation step;
chloramphenicol inhibits peptide bond formation); the Brenner cards dont make
these differentiations, so you could have gone through all of the cards, then get to a
practice question but still not be entirely sure which answer choices are referring to
which drug. I would only recommend this resource if youve already gone through
FA, the Lange cards, and all of the QBank Qs out there but merely want to learn
more drug names out of curiosity. Just be aware that the remaining drugs in the
Brenner cards (i.e. the ones you had not encountered through other resources) are
extremely unlikely to show up on the exam. Dont waste your time with this
resource.
BRS Physiology I purchased this because people raved about it and read the whole
thing. It is a very good text for MS1 to gain a broad foundation in the subject, but it
simply didnt assist me answering USMLE questions correctly. This is what Id like to
call a fluff book. Many people like and/or love it for learning physio, but what I
found with this book was that it was either too general or too specific. It also has
lots of practice questions, but they, once again, werent USMLE-style and were
overly pedantic, particularly with regard to some of the calculations, which are the
type that have never been known to have been tested on the USMLE. The vast
majority of the physio questions on the exam are going to be arrow-questions that
you can answer based on having done QBank questions alone.
HY Biostats overkill; like using LAH instead of NaBH4 on a simple ketone. Read a
few chapters and did some of the questions. Concepts remain important, but too
specific for Step1. Deceitful book: Its very short, but also takes a very long time to
read because of the magnitude of the concepts involved. Stick to practice
questions for biostats. Thats it.
HY Behavioral too general for Step1; I wouldnt recommend this text to anyone.
FA rates it as a top resource. Bogus. Its a total flunk. Read BRS Behavioral.
HY Embryo too detailed for Step1; stick to FA and practice questions, which are
more than sufficient.
HY USMLE Step1 nice cover, but pretty much a low-quality spin-off of FA that
doesnt seem to go anywhere; basically the author just took ~1/3 of FA, summarized
it too generally to be worth anything, and then published it to make money. This
was likely the most worthless text I had purchased at any point during my entire
USMLE preparation.

HY Biochem, Histopathology, Kidney, GI tract, Heart, Lung: all unnecessary. The

worst was probably the histopathology. It was a malfeasance that they even
advertised it as prep for the USMLE. Worthless. The latter four organ system books
were good for referencing at times. They also have some nice radiographic images,
but they are beyond overkill for USMLE prep. Dont purchase any of these.
DejaReview Neuro, Pharm, Biochem, Microbiology & Immunology, and various
others: all unnecessary. I flipped through these on occasion, but they didnt provide
me with anything special; some of the info was also incorrect at times or just too
general. Learn to consolidate resources. I purchased all of these because I was
OCD, but within the final 6-8 months of my prep, they generally just collected dust
on my shelves.
Step1 SECRETS: SECRETS was a very good book, but its extremely long and is not
to be used within three months of the USMLE. This is a fantastic resource if you are
in MS1 or early in MS2, but there are many more important resources out there to
check off on your list before you should even consider SECRETS a priority. I knew a
girl who was in love with SECRETS because she thought it was the greatest book
ever, and she was spending more time on it in the months leading up to the exam
than she was on First Aid or QBank questions. Although I agreed with its utility, be
aware that its actually baneful to get pulled into other attractive resources close to
your exam. If youre within three months of the real USMLE, First Aid and thousands
of practice questions should be your upmost priority, not SECRETS.
CASES for USMLE Step1: a great book early in prep. If you are within three months
of your exam, dont buy this book, but if you are early in MS2, its worth your time
when you dont feel like doing real studying or are traveling by bus/train
somewhere. Dont religiously read this text. Just quickly absorb the vignettes,
relate to the information in the subsequent questions then move on. Dont spend
too much time analyzing this book.
Lange USMLE question books: I have three Lange question books. The questions
arent USMLE-style, but instead similar to the one-liner ambiguous ones that Id
frequently see on my SoM exams.
BoardBuster for the USMLE: another large-ish question book. Questions are either
too specific or unrelated to USMLE material. Some doc wanted to just make money.
Previous relevant review posts Ive made:
Uworld: http://forums.studentdoctor.net/showthread.php?t=958502
Kaplan QBank: http://forums.studentdoctor.net/showthread.php?t=943957
Kaplan QBook: http://forums.studentdoctor.net/showthread.php?t=917952

HY / BRS Behavioral Science: http://forums.studentdoctor.net/showthread.php?

t=920502
GT QBank: http://forums.studentdoctor.net/showthread.php?t=929668
Lange + Brenner pharm cards: http://forums.studentdoctor.net/showthread.php?
t=915419
FA Q&A: http://forums.studentdoctor.net/showthread.php?t=912135
------------------------------------------------

I've also received many post-exam PMs and questions that I'll post below:
Q: Good to hear you did well, hey phloston I know your exhausted and all but if you
could just answer a few questions I would be grateful... exam in a week
1.Having given the exam now what would you recommend is the best routine to
follow in the final week to do to get the most out the last few days?
2.How was the exam compared to NBME? Uworld? Uwolrd assessment exams?
3.Can 90% of it be done from FA as many have stated before?
4. Anatomy was it from FA or should we supplement another source and go through
pictures/ diagrams etc.?
any other avdice which is key to doing well would be appreciated
thanks
A: Hey, man, I am pretty beat right now. I only got 3 hours of sleep last night (the
night after my exam) because I had difficult questions flying into my head that I
wasn't sure whether I had gotten wrong. I even woke up with my heart beating to a
renal calculation question that I thought I may have messed up on. I'm hoping
everything went okay.
As far as the final days are concerned, I had been asking people that question for a
long time as well. I pretty much spent the last couple weeks, believe it or not, at
~50% the workload / # of hours that I normally put in throughout the year. The final
week for me was literally alternating days of just doing an NBME and then going
through a chapter of FA. In the final week, don't study physio. You know that stuff.
Make sure you learn the biochem, micro, pharm and embryo that's in FA. I had one
day where I just did biochem. One day was just embryo. One was just micro. And
the last was just going through the drugs at the end of each chapter and in the
pharm chapter itself. Know your side-effects. I had a low-yield side-effect show up in

a very tricky question, where they wanted you to think it was a different drug they
were asking about.
I would rate the exam much closer to UWorld in terms of question-style and
difficulty than the NBMEs. I found the NBME questions to be either joke-easy or
WTF-hard, no real in-between. The real deal was mostly middle-ground difficulty,
with a handful of gimmies and a handful of hard ones. I found the UWSAs to be
much much harder than the real deal. That being said, I had thought the UWSAs
were harder than UWorld QBank as well.
I would say that FA alone is not nearly enough. I think about 60% +/- 10% of my
exam was straight from FA. The rest was literally all QBank material. When you get
to the real deal, you'll know what I'm talking about. You can read FA, but if you
haven't done a lot of practice questions, you're toast. Do a ****load of questions.
I've read posts in the past where people say FA was >90% of the exam. Those
people either got very easy exams or are just oblivious.
Love that you ask about anatomy. I was worried most about this going in, but I may
have gotten lucky I think. I didn't have too much, but the ones I had were WTF
questions, and for some ridiculous reason, I knew them. There was one obscure
anatomy identification question (go figure) that literally popped up like the 3rd to
last question of the whole exam. It kind of sank my mood ever so slightly, but I tried
not to let it bother me. But yeah, I had no idea wtf it was asking. Abdominal x-ray,
both frontal and lateral views, pointing to different things. Hopefully I got it right.
If I were you (and listen to me square), know your neuroanatomy. This was
exceedingly high-yield on my exam. I had pretty much everything you could have
imagined, and would have been royally ****ed had I been weak in this area. I would
say I'm above average, not excellent, with neuro, and I was still able to get by for
the most part.
Q: Could you also comment on pathology, if FA + pathoma is good coverage? I own
Goljan but it seems low yield.
A: I didn't use Pathoma. I listened to about 2/3 of the Goljan audios but didn't use
the rest of them because I was impatient. I think the audios are great if you're
learning that material for the first time, but if you're approaching crunch-time,
there's other things that are higher priority. The FA% on my exam I mentioned
above.
Q: By "QBank material", do you mean just UWorld?
Because as far as I can gather from the forum posts about the other two banks,
USMLERx is basically just FA and 95% of Kaplan QBank is FA including reference to
the page numbers in FA.

The other argument which I hope someone can answer is, if FA authors have been
clever enough to put all the facts needed to solve all the 10x322+150 NBME
questions in their book, how do the NBMEs still correlate so well with the score from
the actual test that has only 50% of necessary facts from FA?
A: Each QBank contributed something unique. USMLE Rx seemed to draw heavily
from FA with its actual questions, but the explanations sometimes provided a lot of
low-yield factual info. A few drug names popped up on my exam that I had only
seen because USMLE Rx had mentioned them. They weren't the answers to the
actual questions, but I at least knew they weren't right.
USMLE Rx's questions are much more simple than the real exam's. When I had gone
through the QBank in March/April, I thought the difficulty was normal, but I had gone
back through ~5-600 questions within 3 weeks of the real deal (7 months later, so
no, I didn't remember any questions), and they were so easy that I felt it wasn't the
best use of time to tackle the QBank a second time. Once was fantastic. Twice was a
no no.
In short, if I am as objective as I can possibly be, I think FA alone can get you most
of the straightforward questions, just as reading that text would help you with Rx,
but the harder questions require that you know a mechanism really well and then be
able to manipulate it. FA alone can't give you practice with that, and Rx is only the
first step in developing your thought processes.
Kaplan QBank is definitely not 95% FA. KQB was the hardest of any resource I had
used while prepping for this exam, and it had a ton of low-yield info. It definitely
helped with my molecular biology, which interestingly was very high-yield on my
exam.
As far as the NBMEs are concerned, as I've said before, 90% of the questions on
those exams are cake-easy, so it's not a surprise that FA can be generally adequate.
But the curves are extremely extremely steep. When you do those exams, it will
become apparent to you how much bearing the low-yield info has on your score.
Q: No what I meant to say about the NBMEs is that the FA authors certainly would
have seen every single one of those questions and they would have incorporated
the factoids into FA somehow. I haven't taken a single NBME yet but I can bet every
question in them would have the factoids needed to solve mentioned in FA. [B]If
50% of the questions on the actual test needed minutiae outside of FA[/B] to even
solve, I am not sure how NBME tests still correlate that well with the actual scores,
steep curves or not.
If you are saying Kaplan QBank is not 95% FA, I think I should really try it, though I
have no freakin' idea where I would find the time for it! However, I have read at
least ten posts on this very forum by ten different people saying that 95% of the
questions in Kaplan QBank can be solved using factoids from FA and those 95%

even give the page numbers in FA where the answer may be found. That is the
confusing point.
A: The bold is not what I've said. FA may have covered ~60% +/- 10% of my exam,
but that doesn't mean the remainder was minutiae. There are quite a few questions
that require your external knowledge integrated with strong problem-solving skills.
FA does not build your pathology. You need BRS Path, Webpath and many QBank Qs
to cover this area. FA's coverage of path is mere cursory.
I say I had a lot of minutiae on my exam. Probably about 20 questions fell into this
category. They either required you know some small factoid, or you had to know
what you were looking at without the help of the vignette. I'd say two of the hardest
questions on my entire exam included images. Other difficult questions had patients
with presentations I had never seen before. In fact, one of the most challenging
questions on my exam had to do with a vitamin.
If I mention anything related to difficulty and this exam, it's completely objective,
not subjective.
When I said that, for me, "the real deal was mostly middle-ground difficulty, with a
handful of gimmies and a handful of hard ones," that is how I see it in relation to
what I think the % of people answering each question correctly was.
Some QBank questions you do literally have 85+% answering correctly (e.g. here's
a drug causing orange tears/sweat, which one is it?); I just don't feel these were a
humongous portion of my test. I'd say the bulk of the questions fell into what felt
like the "50-65% answered correctly" category.
I probably encountered ~25 questions that were thoughtlessly easy (>80%
answering correctly), but there were also ~25 that were in the <25-30% answering
correctly category. I think I may have seen ~5 that were for sure <20%-type
questions.
Q: Phloston, in retrospect, would you still say UsmleRx over Kaplan Qbank?
For all recent test takers, assuming you have tried both because I don't know how
you can know otherwise (unless you do with a reason .. then that's fair), UsmleRx or
Kaplan Qbank?
Also - I'm doing GT, not sure if that changes anything but perhaps GT is similar
enough to UsmleRx....
A: As I've said before, each QBank has different strengths. Rx was better for
reinforcing FA. Kaplan is good for building your micro and molecular biology. Here's
a post I made about Kaplan a while ago. I mention a bit about it in comparison to Rx
as well: http://forums.studentdoctor.net/show...php?p=12986874

Q: I was going to ask how BRS path compares to patjoma and if one is more dense
or better. I'm trying to avoid goljan.
I never touched Pathoma. I thought BRS was perfect for learning stuff during MS2.
It's basically the FA of path. It's a skeleton to get you started and isn't too
overwhelming (like big Robbins).
A: I own Goljan RR, but had only used it to look at p.57 (I think that's the p.#) on
occasion, which has really good volume vs osmolarity boxes. None of this stuff
ended up showing up on my exam, but the topic was high-yield in the QBanks.
I had spent no more than 10 minutes at different times flipping through random
sections of the Goljan RR, but I could tell that it would have been a great text during
MS2, not something to use approaching the exam. I would recommend BRS Path +
Webpath + tons of QBank Qs as top priority.
Q: Phloston ), if you had only a few days to spare for Kaplan, which sections would
do from the QBank given you have already completed UWorld?
A: I recommend the whole QBank, but if you absolutely need to crunch, get through
the biostats and molecular bio. I would also suggest doing neuro if you can.
Neuroanatomy was one of the highest-yield topics on my exam.
Q: would you say that uworld covers most >85% of the pathology on the exam not
seen in FA, since everyone claims it to be hi-yield
A: UWorld asks questions well within the context of the topics that it does cover, but
overall, it does not nearly cover the breadth of path that could show up on your
exam. Path is one of the most extensive subjects. They can show you any picture in
a patient with any type of presentation. UWorld covers the highest-yield topics well
(e.g. Marfan's, phakomatoses), but the lower-yield stuff can come out of nowhere.
Make sure you know BRS Path, and try to do Rx and Kaplan QBank in addition to just
UWorld; if you don't have time, just try and fly through BRS Path so you at least
know everything in there.
Q: Phloston, would you say that understanding and knowing ALL the info in the UW
explanations w a good thorough understanding of FA would be enough for 220?
A: If you spend the time to learn all of UWorld, you'll do very well. FA is your
foundation, then from there, your score is somewhat directly tied into the # of
practice questions you do. This begins to plateau around 6-7000 questions, but from
there, you are more so just developing rapid recall skills and the ability to
manipulate experimental models than actual raw score augmentation.
Q: Phloston, congrats homie on taking the exam. Was Neuroanatomy really that
high yield? How many questions would you say were on your exam?

A: I had a ventral brainstem pic (identify the nerve based on the vignette), gross
haematoma pic, several MRIs, brainstem transverse cross-section, spinal cord crosssection, and at least 30 vignettes (without images) that relied on you making a
diagnosis or being able to identify the location of a lesion based on the information
given. I'd say ~40 questions on my exam were neuro.
Two of the hardest questions on my exam were neuro. And a third question was of
the pure factoid, esoteria-type; you either knew it or you didn't, and FA didn't cover
it.
One of them had a very abstruse image with a relatively simple vignette. I had
never seen an image like that before. Of the conclusion that I was able to draw, the
vignette just didn't seem to relate whatsoever to the image. I believe they were
trying to pull some sort of trick. Based on what I've encountered through practice
questions in this type of situation, it's important to go with your conclusion of the
image more so than getting pulled into the vignette. So in the end, I answered this
question based on the image alone. I have no idea whether I got it right.
Q: Phloston, why do you recommend BRS path? I don't think I've heard of anyone
recommending it.
A: During MS2, I would read the chapter in BRS Path over the weekend [I]before
[/I]that corresponding topic was covered in PBL. That way, I went into class with a
good foundation, versus just seeing the material for the first time. This helped me
lead the class discussions. I thought BRS Path was absolutely platinum for building
my path. It's mainly bullet points and is super well-consolidated.
Q: many suggest BRS Physiology. Goljian audio is great too but only if you do it
earlier in the year.
A: I read BRS Physio about 5-months-out. I only purchased it because everyone
raved about it, but it was way overkill for Step1. This text earned me zero questions
correct on both the NBMEs and on my real deal. I would recommend this text for
someone in MS1 who wants to build his or her foundation in physiology. However if
you're within 6 months of the exam, this book should be essentially nill on the
priority list. Practice questions and reading the explanations is pretty much all you
have to do for physio. And don't touch physio in the last two weeks. Just focus on
biochem, micro, embryo and pharm.
Q: Now that you are done with the test, what do you think is the highest value for
time in last two weeks? Do you still think FA, UW and NBME or would you include
anything else as well?
A: The highest valued thing you can do during the last two weeks is to sleep as
much as you can at night. If that means getting 9.5 hrs every single night leading
up to the exam, do that. I wore ear plugs and a blindfold and didn't let anyone wake

me. You'll need all of your energy when you enter the real deal. But don't nap during
the day. Just push through your study days and sleep long at night. You need max
REM for your memory.
In terms of resources, the last two weeks should be making sure you've finished
UWorld, doing all of the NBMEs and touching up on the HY subjects in FA. That's it. I
finished my second pass of UWorld right around the two-week-mark from my exam,
then spent the final days on the NBMEs and FA at 50% effort.
Q: What do you suggest for images CT , MRI
Q: Phloston, you say neuroanatomy was heavy on the exam. What is on your
opinion the best resource to study neuroanatomy from for someone with not the
best background? Thanks
A: To both of you: practice questions. That's it.
I had been most worried about anatomy going in because it's not my strong area
and it has been known to be highly variable on people's exams, but practice
questions turned out to be sufficient for me.
Interestingly, as much as I hate Kaplan's question-style, the QBank developed my
ability to read CTs really well. By the time I sat the real deal, I felt very comfortable
with CTs of the thorax and abdomen. This comfort came strictly through practice
questions.
I also recommend the [B]neuro sections only[/B] of the Kaplan anatomy lecture
notes. These saved me on the exam. I wasn't a fan of the lecture notes overall
because I feel they're generally too long and overkill, but the neuroanatomy section
of the anatomy book is spot-on. I didn't read the notes in this section; I just looked
at the images. This helped big-time.
Q: I heard you say micro cards were good and I did go through them once. Do you
think they are useful to keep using in the final few months of prep or did you just
use FA?
A: Going into the exam, I made sure I had the images of the tree-diagram cards in
my head. I had several questions that required you knew the structural
characteristics of the organisms. The Microcards were ultra-clutch and pretty much
got me all of my Micro points on the exam.
Surprisingly, I only had one question on bacterial toxins on the exam, despite these
being very high-yield. It also happened to be one of the trickiest questions on my
form because the vignette was nothing I had ever encountered before. I almost got
it wrong, but when I went back to think more about it, I was very impressed that
they had managed to make such a twisted question out of otherwise very
straightforward material. Know your toxins and how they relate to immunology.

They know people can memorize toxins, but be sure you understand how the
cytokines and receptor pathways factor in.
Q: how much biochemistry/molecular biology should I study?
I have been reading conflicting reports. FA is really short on pathways, with little to
no coverage outside krebs, glycolysis, urea and even those were short. I plan on
doing FA, Kaplan QBank, USMLE World, Lippincott q&a. Is that good enough? Or
should I go to the big lippincott review book and go over all of the pathways?
A: FA covers the metabolic cycles sufficiently. However, the QBanks will clue you in
on how they can be tested.
This means good and "bad" news:
Good news: the only text you need for biochem is FA (and just in case you are
curious, I own DejaReview Biochem and HY Biochem; both were preter-unnecessary.
I also spent about an hour one day flying through a copy of Underground Clinical
Vignettes - Biochem that I had seen laying around in my SoM's bookstore. This was
actually pretty good, but not necessary.).
"Bad" news: you have to do a lot of practice questions to see how biochem's tested.
The USMLE likes to mesh the biochemical pathways in with enzymatic
phosphorylation/dephosphorylation, cAMP and pathoendocrinology (e.g. hormones,
congenital disorders). Biochem is also a prime target for minutiae questions. The
QBanks will fill you in on the details you need to know.
Kaplan QBank is the best QBank for building your molecular bio.
Q: Similar question for anatomy. FA is very, very short on anatomy. Again is FA +
Kaplan QBank + USMLE World good enough for the score I am aiming?
FA + the QBanks + neuro-only sections of KLN + Underground Clinical Vignettes
(anatomy) is sufficient. The latter isn't necessary, but is only a 10-15-hr read, so I
still recommend it.
A: Now let me just make a point clear: anatomy stands as the one subject where
your external knowledge is most critical. You can't get this through USMLE
resources. This comes only with having been an anatomy tutor or a lab aficionado
during the first two years of med school. When I say that those above resources are
all you need for anatomy, they're in actuality just all you should be using during
your study period.
I own BRS Anatomy, HY Anatomy, USMLE RoadMap Anatomy and KLN anatomy - all
were a waste of time. QBank Qs will make you aware as to how anatomy is tested.
These latter texts are consonant with lab-based anatomy-learning during MS1/2, but
they are too generalized for helping you answer USMLE questions. Just do tons of

practice questions and quickly review the [B]neuro sections[/B] of the anatomy book
of the KLNs.
Q: Phloston, Is it worth getting kaplan Qbank only for the mole bio section if I'll also
be doing Rx and UWorld?
A: It's worth getting Kaplan QBank not just for the molecular bio, but for everything
is has to offer. There are quite a few lab techniques as well as analyses of plasmid
construction / gene transfer that are assessed in KQB that are simply just not
covered to the same extent in Rx or UWorld.
This also refers to testing you on conjugation, transduction, homologous
recombination, site-specific recombination, phenotype masking/mixing,
complementation and antibiotic resistance mechanisms.
This is not to say that you would necessarily be lost on these types of questions on
your actual exam if you didn't do KQB, but what I can say, in relation to my exam, is
that I had 4-5 questions with regard to the mechanisms above, where I tackled them
based off of my external knowledge for the most part. One or two were basically
rapid recall. But another two were questions I had marked on my form (i.e. I wasn't
100% sure). For these, the background knowledge that I used to narrow down the
answers likely came from KQB more than any other resource.
When I went through UWorld after KQB, I noticed that they very briefly touched
upon some of the molecular bio topics, but not nearly as comprehensively as
Kaplan. That's also for a reason. Molecular bio isn't the highest-yield topic ever, but
Kaplan for some reason likes it.
On my exam, I feel 4-5 questions is actually a lot to ask on pure molecular bio (i.e.
mo bio not integrated with pathology or biochem; just pure mo bio). I think I may
have expected perhaps one or two questions on plasmid construction or gene
transfer, but I had double that number.
The question I had on transfer of genetic material was quite nebulous. It fell into the
category of one of those reasoning questions that you just can't prepare for, but if
you understand how the process works, you're in a better position to think your way
through what would or would not be reasonable.
Q: What about the Neuroanatomy section of Webpath?
Some folks who had taken the test had recommended it. For those of you who have
done it, can someone point out what precisely needs to done.
There are whole set of Anatomy Images and some quizzes, so it seems a bit
overwhelming.
A: Just do the examination questions. Don't worry about the slides or tutorials.

Do the questions in topic-specific blocks as you move through MS2. These are great
to end your week or to prepare for exams.
I never looked at the pathology slides/tutorials. I just did the questions.
For anatomy, on a few occasions when it would be late at night and I couldn't do
any form of reading because I was too tired, I would listen to music and run through
their head-to-toe cross-sections. These aren't necessary, but once again, they're
good if you're too tired to read but still want to study.
But in short, when I recommend Webpath, I'm referring to all of the examination
questions. In terms of slides/tutorials, use those at your leisure, but they are not a
must.
Q: What do you think about doing a radiology elective during this month off versus
trying to blow through a Q-bank potentially? am I overdoing it by taking a radiology
elective with the sole purpose of nailing every radiograph/CT on my test?
A: Absolutely do not opt out of doing a QBank in order to do a radiology elective.
QBank questions are your best friends. Always.
The imaging that shows up on the exam will be completely random. You will not be
able to directly prepare for it in a reasonable amount of time. It would be like
studying all of the insertions/origins of the muscles hoping that one could possibly
show up on the exam, when meanwhile having spent all of that time doing more
questions or reading FA would have been 20x as beneficial.
So yeah, know your basic radiology well. Kaplan QBank has some good CTs in it. Just
be able to read CTs of the thorax and abdomen, and be familiar with MRIs of the
knee. Those three things are the highest yield.
Q: when do you think is a good time to start doing uworld? I've been preparing for
the test for about 4 weeks now, haven't done Uworld b/c I haven't gone over
everything in FA yet. Should I just get it now before going over all of FA or wait until
I've at least finished it once?
Thank you so much!
A: BRS Path, Webpath (examination questions only) and QBank questions are top
priority for path. Don't worry about Goljan RR or Robbin's.
Start your first pass of UWorld ~2.5-3 months-out. Be sure to give yourself a solid 6
weeks to get through it because it will take a lot of time.
The first thing you should do with regard to USMLE prep is to read FA and go
through USMLE Rx QBank. Those two are collectively one resource because they're
both by the FA authors. Once you get through your first pass of FA + Rx, you'll
already be at the high-230 or low-240 range. Do UWorld last.

Q: I know you highly recommended physio and molecular bio section from the
Kaplan qbank... Any other subject?
A: I would also recommend going through the biostats. Biostats is one of those
subjects that you can never get enough practice, so be sure at least to go through
those questions too.
Q: pholston some stuff just seems so lowyield. we cant possibly need to know stuff
like ependymomas having their rod shaped blepharoplasts.
A: I will just point out that that detail is mentioned in FA. Anything in FA, regardless
as to how pedantic it may seem, is fair game.
Q: When you and others who have taken the test say the exam is different from
NBMEs and UWorld in that the questions there put you in places where you have not
gone before and makes you think hypothetical situations, what exactly do you
mean?
Could you give me examples of such questions? Is it something like this is this
pathway, what will happen if this gene is missing or if we add this miraculous drug
that only blocks this enzyme, etc? If so, that's alright for biochem where most stuff
is pathways and already follows a logical progression but how can that work for
other subjects like micro, systems, etc?
A: I'm not entirely sure what you mean, but it seems like you're already aware that
you need to know various mechanisms well enough to be able to manipulate or
extrapolate from them. I would say this applies best to your cell signaling pathways
(e.g. G-protein, MAP kinase) and the lac operon.
Q: Yeah I meant about just that. I remember you posting something about the
questions on the real thing are a lot harder than the NBME because it required a lot
of manipulation. I was just wondering where all this applies, apart from the biochem
pathways.
A: The harder questions will integrate many concepts, particularly endocrine. For
instance, they might ask you about a gene knockout that affects calcium-sensing on
bone but not on enterocytes, and then they might also tell you that the patient has
a long Hx of uncontrolled diabetes (so you'd need to infer secondary
hyperparathyroidism); then they'd possibly show you some table asking you, with
arrows, about how calcidiol, cholecalciferol, (24R)-hydroxycalcidiol, phosphate, and
ALP would all be expected to change based on the mutation. Now it's not that this
question would necessarily be exceedingly difficult as much as it is that you just
need to know vitamin-D and Ca-PO4-PTH mechanisms really really well, and then be
able to understand how the arrows would change based on the knockout they give.
Most often, you'll actually get a much more simple question than the above one,
where they'll merely just ask you for Ca, PO4 and ALP levels (with arrows) in

secondary hyperparathyroidism (which you'd have to infer based on the pt's

presentation), but the caveat is that they'd then throw in an additional variable that
most people likely haven't heard of before (e.g. osteocalcin, osteoahderin, DMP-1),
and it will come down to you literally having to know that variable, and there's no
way out. You either know it or you don't, and it's not in FA. This is an example of
where low-yield info can come rushing up out of nowhere.
Q: Pardon my manners, happy new years. What do you recommend for sleeping the
night before? How was workout schedule like?
A: Two cups of chamomile tea with milk and honey, one hour apart, but not within
one hour of bed (if you take them too close to bed, you'll have to wake up in the
middle of the night to micturate). Don't use any medications, etc. I averaged
probably ~4 days/wk at the gym during my final two weeks. Definitely work out if
you can.
Q: Did you go over the all of NBME wrong answers a day before the real exam?
A: I made a Powerpoint with all of all incorrect questions (or ones I had answered
correctly but thought were strange). I went through most of them a few days before
the exam. The day before, I actually did very little studying. I went through the
remaining incorrects from the Powerpoint, but there weren't many at all.
Q: Should I keep the online NBME towards the end of my dedicated study period?
A: Yeah. Take one or two online ones outside of the 6-week mark. But take the
remaining online ones within the last ten days.
Q: In one of your posts you mentioned that you used offline nbmes after taking the
real/bought ones to learn from. Do you know how I can get them? Also, do you know
where we can find the answers?
I tried searching and asking around but had no luck. If you can point me in the right
direction I'd really appreciate it. (I plan on buying them too but I like the idea of
being able to look through the questions and answers afterwards)
Thanks a lot!!!
A: I had made a thread about where I could find the offline NBMEs a while ago, and
someone PMed me, granting me access to his/her Google account, where I was able
to temporarily access them. I suggest you just make a thread asking where you can
find them. You'll likely get PMed.
Q: Also, did you memorize all the cards or just the cards pertaining to the microbes
in first aid?
A: Know all of the organisms. I've seen each and every one show up some way
some how during my prep / on the exam.

Q: Does it matter what edition of microcards you use? I ordered 3rd edition but
instead they sent the 2nd edition and I'm wondering if it's worth the S+H back to
get the 3rd edition. thank you!
A: I used the 2nd edition. They were more than amazing.
Q: Hey phloston did you start first with firsaid then reading som books?And at wich
stage you become able to know all information before doing quest? Thanks
A: Do a pass of FA before you start any questions. This way, you're reinforcing, not
just blindly learning for the first time through questions.