So I figured I would share my Step experience with everyone on VMD, especially now that the passing score has been raised, AND there seems to be a shift in emphasis for the USMLE. Let me first say that the first thing one must do to prepare is not to study, but PRAY. Pray hard, pray as if tomorrow is Armageddon for it surely is, for you at any rate.

Before I begin my in-depth analysis (that hopefully doesn't conflict with the NBME not wanting you to discuss what was on the test per se), let me preface this by saying that my experience will not be the same as yours. While trying to study I was juggling a tremendous amount of responsibilities and incidents (close to 3 weeks being sick, hosting parties for Ambassadors/Consulate-Generals, Puppy with Tetralogy, etc).

NOW, ON TO THE REVIEW!!

PREPARATION:

a) Books Used
-Kaplan Series:
The Kaplan series is probably the gold standard that everyone uses to prepare for Step 1. But let me just say that you only REALLY need to use a few of the books/sections. The pathology book for Kaplan I hate to say is not a book you should be using as your primary source under any circumstance. Physiology thankfully is more than enough, as is Pharmacology, and Biochemistry. Microbiology and Immunology likewise is sufficient for most of your needs.

-BRS Pathology:
I found this book to be an EXCELLENT source. If you read each line carefully and annotate, it's wonderful. You'll get most of what you need from here, and Goljan, and there's significant overlap too which is good.

-BRS Cell Biology and Histology:
Good review! The USMLE made a HUGE emphasis on Cell Biology (more on this later). Though I studied it a long time ago more for the shelf exam, than for the USMLE. But it was there like a nightmare!

-BRS Physiology:
Compared to what you learn in class, this book is too skimpy on details. Best to use Kaplan for your primary review book.

-First Aid 2004:
Let me bow down and kiss the author's feet. I had at least three images come straight out of this book. One illustration, and one graph likewise seemed to have been photocopied from here. Most of my microbiology came straight out of here, very straightforward and rapid-fire (even their "tricky" one for which I have not stopped cursing the NBME for was in here). I would guess at least 10 more questions were straight out of First Aid, little thinking required.

b) Study Method:

My study method was unorthodox. I should've stayed on the island for a month or two. Coming home was a near disastor as I was always either at the airport, or in the hospital. But I did my best to isolate myself and study as best as I could. I recommend, strongly recommend, that it is better to find a place where you can focus on studying only for a short while, then to drag it out for a long time with inconsistent study hours.

During studying, I wrote down everything I thought would by HY that I did not know. I used that list to look over again and again so it became ingrained in my head. While doing the Qbanks, I would also take notes, and made sure to do about 100 questions a day.

Summary: ISOLATE YOURSELF AND STUDY

c) Qbanks Used:

-Kaplan Qbank:
What a joke. I would not bother with Kaplan Qbank anymore, even though I know everyone will buy it anyways because it likewise has become the gold standard. But it is NOTHING like the real USMLE. The only thing similar was question lengths, that is all. I'm being serious. Kaplan Qbank should become a secondary qbank for you to use.

-USMLERx:
From the guys who brought you First Aid you'd think this would be superb! Nope, sorry. There's a sticky on this, essentially it just quizzes you on what is presented in the latest edition of FA. Don't bother with this unless you're really desperate for more questions and having trouble memorizing FA.

-TommyK's Concepts here on VMD:
Guys, do these questions, as much as you can. Especially for immunology. Immunlogy is likewise becoming HUGE on the exam. TommyK has done a wonderful job of presenting HY facts that WILL show up. Do them, and they're free!!

-USMLEWorld:
Ah yes, USMLEWorld. The gold standard for Step 2, in my opinion is now also the gold standard for Step 1. YES, the questions ARE harder than the real thing. The format is VERY similar to the real thing (I felt like I was at home doing USMLEWorld when I was taking the real USMLE). The concepts they test you on are similar to the stuff the real USMLE will want to nail you with. Read all the explanations, even if you got the answer right. You'll learn a tremendous amount without opening a book!

The downside is that the questions are often very long. The real USMLE, even the vignettes were much shorter and straight to the point, so it might throw you off guard. Also, USMLEWorld does not focus much on cell biology and immunology. A significant oversight I'm sure. But still, if you're only going to get one Qbank, make sure it's USMLEWorld. Not to mention, as someone before pointed out, I think USMLEWorld or the NBME copied each other. I had a few questions that were near verbatim to each other. Make sure you go through this question bank several times, thoroughly!

d) NBME Comprehensives:

Yeah, take them, definitely. It gives you good practice in taking a USMLE test without any feedback on how you're doing while timed and scored in a similar fashion. A nerve-wracking experience in of themselves. I would recommend taking all 4, don't miss any of them.

But let me just say, I did not think any of them represented the real USMLE. Sorry, but that was my opinion. But invaluable practice.

THE USMLE:

As an introduction, let me say that the USMLE did not feel like it was really testing my thinking abilities. If you know how to read the questions, what to look for, it is pretty much asking, "did you memorize everything?" And the straight-out fact questions were more numerous than the vignettes.

The straight-out fact questions can be harder than the vignettes in fact. Actually, in my opinion, when taking the test I feared these types of questions more than clinical vignettes. They would often ask very nitpicky details that are often times NOT in any of the review books (let me emphasize that again, you better have been paying attention in class). I found myself often having to try to think back to the lucid moments I had between naps during class to remember. And the answer choices they give will almost always be appealing and 99% correct, but they want the one that is 100% correct. If that doesn't make sense, sorry, but just know if you don't know the details of what they're asking for, and paying attention to EXACTLY what they're asking for, a lot of the answer choices will hard to distinguish, and you'll choose the wrong one they want you to choose instead of the correct answer.

As for the clinical vignettes, they'll often give you all the information you need to either know what it is, or eliminate by process of elimination. I found these to actually be the easiest types of questions.

Also, maybe some of these were experimental, but they REPEATED several questions. I'm not saying verbatim, but the diagnosis, disease, and sometimes ANSWER were the same. At first I was shocked and thought there must have been a trick. So I read the questions again and again and again. But yup, they repeated concepts/answers on my exam. Lazy buggers.

Be sure to approach each question reading it not for the numbers, statistics, etc. You'll be able to tell what the patient has, but you need to read the question very carefully for what the USMLE is ASKING YOU! Very important, there were many times I wanted to jump up and shout at my computer screen, "Got you you tricky sucker!!! You almost had me!!!" Highlight, and read again!!

-Let's break it down now into subject matter

ANATOMY: There won't be much on here, sorry. I know you guys spent hours and hours of countless days in the lab, your hands becoming raw, eyes running, and the back pain of being hunched over. But the sad fact is, they'll only ask a few questions, and most of them will be fairly straight forward. My test heavily emphasized the brachial plexus. So if you don't like the brachial plexus, you better start to love it!!

BIOCHEMISTRY: Oh thank you Jesus! My weakest subject because as soon as I passed out of the class I dumped all that information. There was not many straight out pathway questions. I only had two of that kind. The rest were vitamin questions. Heavily focused on vitamins in fact. Know your vitamins cold.

EMBRYOLOGY: I only likewise had two "Straight-out" embryology questions, the kind that ask you at what week or what have you. I think I got 50% wrong then :-). Otherwise, embryology was embedded with pathology type questions, like Down's, Turner's, Edwards, etc.

GENETICS: Wow, this was BIG! And I mean BIG. Luckily most of it was straight out genetics questions. You either know it or you don't, which one is AR, AD, X-linked, etc. I only had one transgenic mouse type question thankfully. BUT, yes, there's always a BUT: KNOW THE PROCEDURES OF VARIOUS GENETIC TESTS! You know that molecular genetics portion of the class you always hated? Yes, it'll be back on the USMLE, and it'll nail you if you don't study things like PCR, Elisas, Coombs, etc. Welcome to hell.

BIOSTATISTICS: HA! My ONLY calculation problem was a biostats question.. and I think I got it wrong . The more I thought about it, I think I used the wrong formula, lol. Oh well. Otherwise, they were heavy though on understanding the various ERRORS that can occur in tests. I think they want future doctors to understand the errors of medical tests and statistics and what it means. So make sure you review such things as confounding bias, lead-time bias, recall, etc.

BEHAVIORAL: I am going to split this up. Normally ethics will go in here, but I'll reserve that for its own section. Behavioral is a joke. It's FREE points. If you even looked at the front cover of your text book you'll do fine. Very straight out, "What's this patient suffering from?" type of questions. Though I did get one developmental milestone question that I fell flat on my face with. Stupid developmental milestones.

ETHICS: I used to joke about ethics. That all you needed to know was WWJD? What Would Jesus Do if he were a psychiatrist? And on every test, question bank, that has served me well to get near perfects in that regard. But not for the USMLE. The USMLE is well aware that most people can read and choose the most polite and butt-covering answer available. What they want you to know is WHAT IS THE LAW? In a given scenario, how would you tailor your answer LAWFULLY? This is another example of how review books failed. If you still have your ethics book, dig it out. There were quite a lot of these.

IMMUNOLOGY: I said it before. This was one of the most heavily tested subjects. Everything about immunology was fair game, and I believe everything WAS tested. If there's one subject you're going to start and end studying with, immunology should be it.

They asked everything from first responders, to ligands, to cytokines, interleukins, recombination, hypersenstivities, EVERYTHING to do with it, and it was through every block of my USMLE. STUDY IT! TommyK does a good job. Memorzie Kaplan thoroughly, First Aid, EVERYTHING! Did I stress that enough you think? EVERYTHING!!!!!!

CELL BIOLOGY: I have also heard from other people the huge emphasis the USMLE is making on cell biology. And cell biology is the class everyone DOESN'T remember taking. Luckily, I was one of those bio majors in undergrad that took his degree seriously, so I knew a lot of what was being thrown at me. And the USMLE gets VERY VERY specific with these types of questions. It will literally seem like they were testing you at the masters levels for cell biology. I had ONE histology question.

MICROBIOLOGY: As I said, what you need to know you can get from First Aid. 90% of the time they'll only ask you about the major players, the ones you should know or go back to medical school. But the questions were very similar to the microbiology shelf exam: VIRULENCE FACTORS! KNOW THEM COLD!

NEUROSCIENCE: This is likewise becoming a bigger and bigger part of the USMLE from what I've been hearing, and my exam was no exception. Luckily, a lot of it can be gleamed from First Aid, but to be fair I was very good at neuroscience. Neuro was a pet subject of mine as an undergrad, so I barely focused on it. But expect all the standard fair game questions: Tracts, Lesions, Blood flow, etc. Be prepared, it'll be straightforward, but more than you expect!

PATHOLOGY: I know you guys won't believe me, but there wasn't that much direct pathology. There was a heavy emphasis on UTIs/genital tracts, but outside of that, there was a smattering from each topic. But seriously, for the heaviest subject in your Basic Sciences, this was very underrepresented. I had like two (TWO!!) kidney questions, nothing on breasts, or genital cancers. Do know your Hodgkins, Non-Hodgkins, leukemias, etc. Those are free and easy questions and are plentiful to boost your self confidence. And, eer, I know you guys are disappointed, but that's all I have to really say about pathology.

PHARMACOLOGY: Relax. I know most people hate pharm because it's just pure brute memorization. And for the most part, the USMLE is understanding and will ask you fairly straightforward questions. But be warned. There was an incredible amount of questions dealing with pregnancy for pharm, questions to which I couldn't find straight answers to when I got home (they may have been experimental). But be prepared for pregnancy contraindications. Actually, just know contraindications in general!!

PHYSIOLOGY: Another fairly straightforward part. You'll get things like graphs, tables, and even illustrations. For the most part, you either know it or you don't. Reasoning probably won't help you. The trickiest parts were the ones with arrows, YES, these WILL be on your test. They come in varying difficulty. There were several where you could get 3-4 of the columns down, but that last variable you had no idea even what the heck that is and it comes down to a 50/50 chance. Others can likewise be quick and painless. My test did not emphasize any one system, but had a good smorgasboard of everything. Be sure to study physiology as thoroughly as possible. I was extremely lucky not to have any calculation problems.

PICTURES/SLIDES: As I said, a number of them came straight from FA or from USMLEWorld. They also choose ones that are the most representative and easily discernable if you know what it is. There were a few though that the picture was necessary to answer a question, but most of them the pictures were the answer.

TAKING THE TEST:

Everyone has a different pace. I finished each block with about 15 minutes to spare, and took another 5 or so to go
over my questions. In general I didn't change my answers, usually your gut instinct will be right as you may have chosen it for a subconcious reason, as in the knowledge may have been buried there and has magically guided your mouse cursor to the right answer. The one time I remember which answer choice I changed, I got wrong, bummer.

After each block you're given an opportunity to take a break if you need, with something like 45 minutes calculated into your total time to take a long lunch break. If you need to use the bathroom in the middle of a block, that WILL be noted on your record. So save your pee or poop for between blocks. I would recommend NOT bringing a heavy lunch. You want something high energy and that won't put you into a food coma.

AFTER THE TEST:

You have 3-4 weeks before you can do the Oasis trick and see that beautiful red. Keep yourself occupied. Whatever you do, do not try making a list of every question you had trouble on and seeing if they were right or wrong. I drove myself insane and was absolutely sure I failed (in case you didn't guess, I didn't fail).

The last few days are the hardest before you can do Oasis, go out, get yourself drunk or otherwise preoccupied.

GOOD LUCK TO EVERYONE!!

Notes:
1) Be sure to concentrate on everything related to Pregnancy. Pregnancy related concepts and contraindications popped up across the board.
2) Genital systems and pathology. Suckers kept cropping up everywhere. Know them.
3) PRAY!
4) Be sure to memorize the Pharm Contraindications section in First Aid. Believe me, you'll want to send me $10 for reminding you to do this.

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I enjoyed reading this, very lively and upbeat, because when I think about taking it, the first image that pops into my mind is the Reaper.

You brought up some things that really hit home for me, like isolating yourself when studying. Man, I have gone through so many locations, all of them seem to suck! From cafes to libraries to my own study at home, on my own or with others, and none are perfect . So I take heed to studying strongly in shorter spurts. Thanks, and here's to your getting a strong score!

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I used to pray and pray for a bike and never got one. Later I learned that God doesn't work that way... so I went out and stole a bike and asked God for forgiveness.

Hey CC,

Did you score acceptably well? I did! Woohoo! Are you waiting for Bakersfield or are you going off immediately?

-Mr. Pathology, from ICM.

Thank you SOE That's a moral boost!

I wish you all the best

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Something that bothers you, just flush it off and wipe the remaining patiently. RS-Stanislas

Thanks for the input.

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Moderator: USMLE Step 1 Forums, USMLE Step 2 Forums,USMLE Step 3 Forums.

Some day I will be the next Goljan/Daugherty/fysher for IMG's all over the world.

Yo ho yo ho a pirate's life for me. I did acceptably well. I was hoping for more, but I'll take whats I gots (considering I was praying for just a 185!!).

Yeah, I'm waiting for Bakersfield, which gives me a very loooong vacation. How about you?

Also, to share your thoughts about the test. Did you feel this was a thinking test or regurgitate test? Quite honestly, the clinical vignettes people worried about were probably the most straightforward. The rapid-fire fact questions were the ones that scared me the most.

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Well, I think everyone hopes for more. I did meet my high expectations and strangely enough, or maybe not, the NBME online exams were exactly correct in their predictive value.

I'm not sure where we are going yet; I hope to start in July, so probably NYC. It's just so darned expensive. Alas.

I still don't know about the test, even four weeks later. I felt going into the exam that I was well-prepared; the questions I actually got were very difficult and in many cases seemed to be totally foreign or unexpected.

For the vignettes, I got very few "Sudden onset fever and epigastric pain radiating to the back, hx of EtOH abuse, elevated lipase and amylase" kinds of questions that Kaplan Q-bank seemed to favor, so that was very annoying. I got endocrine questions with two separate, unrelated disorders, and then answers that referred to both disorders. I got stupid heart sounds questions -- should have paid better attention to Harvey! I was concerned about pharm (not because of Dr. C, but because I didn't study it for 6 months, and I never really learned Chemotherapy), but it went fine (except for the 5 detailed questions on AIDS therapy that I am pretty sure I missed). I was concerned about viral genomes (which I tried unsuccessfully to cram), but only got one obvious question on them.

I felt the rapid recall questions of silly facts actually went quite well; I didn't notice any that I didn't know.

Other than that, things went rather well in the end, even though I felt abused coming out of the exam.

Rant: Kaplan Q-Bank was WAY OFF as preparation for *my* exam (YMMV); since I did no other questions, I REALLY feel ripped off and cheated. By the time I finished Q-Bank, I could read the first two lines of a question and know what it was going for, and predict the possible answers and then get the right answer 75% of the time. This is basically what I expected my exam to be like, and I feel like Kaplan is doing a MAJOR disservice to their students in this regard. I was major Kaplan backer before this test: I used them for SAT and got a 1420; I used them for MCAT and got a 34 (and I still go to AUC!! Joke's on me!!). The difference this time as opposed to those other times, was when I finished those earlier exams I left feeling very confident that was going to do well and that the preparation was worthwhile. For Step 1, however, I felt like the whole 2000 questions was a waste.

I didn't learn about USMLE World until like 10 days before my test, so no luck there.

I am typing too much, and I need to do my financial aid and vaccination stuff. I will perhaps write more later.

Absolutely. Kaplan Qbank was waaaay off for the USMLE. USMLE World was beautiful with several questions being on the actual USMLE, hehe.

Yeah, I was concerned about pharm as well, especially when they were hitting me with pregnancy related questions. Luckily I think those were all experimental questions. Had many pregnancy related questions in fact, I was going into a slight panic as I don't think we had learned much about path/pharm/biochem/etc related pregnancy outside of the obvious birth defects or teratrogenic ones.

But all in all, I felt it was a "you know it or you don't" test. Maybe because I practiced a lot with USMLEworld that the question format and what to look for didn't surprise me.

You know, I never got the chicken pox.. this worries me.

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