step 1 experiences :by ron

Hi all,
I just received my score today. 221/90. I'm happy :) Posted my experience 4 weeks ago, right after my exam. It is copied below -- it answers the common questions of "what books to use" "Q-bank scores" "what types of questions on the actual USMLE." Hope this helps you all, and I'm happy to answer questions. And please make sure to help others after you've taken your exam.
--ron
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I just finished my exam about an hour ago. I had dreamt about being on “this side” of it for weeks now, and have looked forward to writing this post. It would mean that I have finished – finished with 3 months of intense studying (dare I say “hellish”?), of being frustrated at myself for forgetting and having to re-learn and forgetting again. It would mean that I get to move on with my life. It would mean that I get to spend more time with the people I love and care about.
Let me tell you how my exam is – since it is still fresh in my mind. I am disinclined to tell you about specific questions I had, but will tell you topics I saw.
Oh yeah, I’m sure everyone’s difference will be different. But I will tell you mine.
So there were 7 blocks, and the day is long. There were many people taking the exam at the Prometric Center, but I was the only USMLE (most people were taking the GRE). I was schedule at 9:00, so showed up at 8:30. Everyone is scheduled for 30 minutes early, because they have to check in people one-by-one into the computer room to take exams. This means if you show up early you will get to take your test early. I didn’t get to choose a computer, but I was nice to the lady checking me in so she gave me a corner. I wore heavy earphones the entire day, and that was extremely helpful in eliminating noises. The “lockers” you are given are very small – definitely NOT big enough to fit a bookbag. They had a dorm-sized fridge that the employees use and was offered to me, so I would store food. (I didn’t check to see if there was a microwave – I ate sandwiches).
Okay, the test. ALL the topics were covered – and I’m glad I gave all the subjects some coverage during my studying. Stuff like biochemistry and genetics and immunology and behavioral science were also well-represented. I was actually quite surprised at how much biochem and genetics and immunology there was. I mean, not like 50% of the test, but if each was between 5-10% of the test that adds up to a big portion of the exam and will make a difference between passing and failing, or between a 250 vs. a 200.
I was surprised by how many PICTURES there were. This is one area I neglected to spend much time on – mostly because I didn’t know a good (high-yield) source for pictures. There were X-rays, histology pics, and quite a few brain pics (MRI, cut sections of the brain, and drawings of the brain). There were also schematics drawn for physiology and pharm questions – like if drug A is added to drug B then these are the curves for activity. Or a drawing of a nerve and you are asked about the neurotransmitter location. Or picture of a nephron asking for location of action, or your standard heart tracing (see First Aid). Overall, I would say that about one-third of my questions had a picture attached.
Overall, I thought the test was fair. If you learned absolutely nothing in medical school, the standard A-list of materials will get you through the exam in flying colors – IF you know how to USE the material. I had very few purely fact-recalling questions – it was practally all application types of problems. The sections of the test are of differing difficulty. The first section was okay (I felt it was like Q-bank, and I could probably guess the % I got right on the first section). The next 3 became quite a blurr, and I got a little depressed and starting hoping JUST TO PASS. The next 2 I think I KILLED (felt like when I the first section of the USMLE CD for the 3rd time). The last section was okay. I’ve heard similar things from my friends. My advice: when you stuble across the tough sections, take some breaks and allow your brain to be fresh. That’s when you need your brain-power the most.
Pathology: some people on this forum have said that their exam was made up of mostly path (like 70%). So I hit path pretty hard during my studies. I would say that my exam was probably 1/3 path. I remember a lot of NEUROpath, and I’m glad I studied that. Recommendations: BRS Path and High Yield Neuroanatomy. Oh yeah, and there were a few congenital diseases (probably 5 total) – just study your very common ones. First Aid probably enough for that. No use wasting time on embryology for those 5 questions.
Physiology: there was a good portion of physiology and pathophysiology. I remember heart, kidney, acid/base, pulm, endocrine questions. I strongly recommend BRS Physiology. It’s all I studied for physiology and it’s the only questions I did to practice. I think I probably did the best on physiology on this test.
Pharm: pharmacokinetics, adrenergics/cholingergics, scattered other pharm questions. I only studied pharm cards (and also read the PK chapters in Lippencott). The day before the exam I read the First Aid section on pharm (excellent review). I thought that was plenty.
Micro: I knew my bacteria, but have probably forgotten 80% of viruses and protozoa and fungi by today (didn’t have time to review everything!). I think I did okay on micro. The only thing I studied for Micro was Micro-cards. Tried to read Micro Made Ridiculously Simple when I was taking micro in school, but didn’t get through but the first 2 chapters (too dense for me).
Behavioral science: There was a fair amout of this on the exam: maybe 10-15%? I bought BRS and High Yield (I was overzealous). Ended up only studying the stages of development (after so many months you should be able to walk, to play with others, etc), defense mechanisms, the personality and psychotic disorders (these from first-aid), ethics, and biostats. I think I killed behavioral science. For ethics, I read the posting on this forum for the Kaplan rules (you can search for that message by typing “ethics”) and read both HY and BRS. For biostats I did the problems in BRS. The day before I looked through all the examples for the defense mechanisms in FA, HY, BRS. These areas I mentioned are HIGH YIELD. I have absolutely no idea how many people in the US are addicted to whatever drugs, or what the risk factors are for divorce or whatever else there is to study in Behavioral Science. But that was okay.
Anatomy: I’m very glad I studied this. Recommendation: High Yield Anatomy, plus look up all the structures mentioned in there in an Atlas (I used Netter, which is what we used in class). I think that was plenty for Anatomy. Hard to say what the “important topics” are… there were questions about specific nerve injuries leading to certain symptoms, the relation of structures to each other, lymph nodes cancers spread to. HY Anatomy was a great book to study.
Biochem: there were enzymes asked I didn’t know about, and there were questions about the fuctions of different parts of the cell. I thought I would get by with First Aid because I was a biochem major in college (3 years ago). Alas, I had to take a loss on this one. I would recommend High Yield.
Immunology: I studied First-Aid and that’s it. I would recommend High Yield on Immunology (it’s only like 70 pages… but I didn’t have time to read).
Genetics and Cell Biology: there were pedigrees, and there were experiments described where you had to interpret results. I didn’t study much because I’ve done quite a bit of research.
Overall, I would highly recommend studying ABOVE and BEYOND first aid, and then in the last week just read first aid for review. This is my argument for this plan for studying: the USMLE is designed so that the average medical student (like 93% of AMG’s and I don’t know what % of IMG’s) can pass. The average medical student studies First Aid – so if you study above that, you will do fine. But, in the last week, you need to make sure that you hit First Aid and know it cold. That will get you to pass, and the knowledge you have from the rest of the studying will get you to do above average. If you try to do too much in the last week (like I), you risk not knowing what the average medical student knows.
Q bank was good, but I only did about 35% of it. (it’s more my style to spend time studying than practicing). In the end I was getting between 70-80%. I’m hoping for a similar percentage of questions correct on the actual USMLE (hoping my good sections will be enough to balance out the bad ones). I also did the USMLE CD – but did not do BSS or any of the other popular question banks.
Just so you know my perspective… I’m a current American medical student right before starting 3rd year. I felt that I learned almost nothing relevant to the USMLE prior to studying this summer – so the list of resources I mentioned got me from almost scratch to hopefully passing above average. I started Q-bank at about 45% and the USMLE at about 50% in June. Studied about 3 months, more than 12 hours each day (some times a lot more), except for 4 weeks when I had class (during which I studied about 5 hours each evening).
Good luck to you all. Please… when it comes your turn, contribute to this forum so others can benefit. This has been a wonderful resource for me the past 3 months, please help continue it. I’m starting surgery tomorrow (Monday), so will not have that much time to answer questions – but will try.
--ron