Step 1 USMLE Do It Like You Own It (Road To 253)

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Step 1 USMLE: Do it like you own it (Road to 253) Authored by Dr. Jagjit Khosla (Jags)
Step 1 USMLE: Do it like you own it (Road to 253)

Source : https://iamjagjit.wordpress.com/ (My blog)
Background
I am graduate from UCMS, Delhi, India (batch 2007).
Sometimes in life you have to make a choice Either continue to
live the life of mediocrity or set sail for never ending pursuit
towards mastery
I made my choice and thats how the journey began There were three phases in my preps
Phase 1
I started doing subjects one by one and did it like this I used to see Kaplan videos along with
notes for one subject, supplement it mostly with one extra reference book for that subject then
read first aid of that subject and add all extra important info into the first aid in empty spaces n if
required I added extra sheets following this I used to do subject wise Uworld questions on that
subject (and even chapter wise for pathology) and while reading explanations I used to add all
that was missing in my first aid I did this for all 7 subjects took me about 5 -6 months to do all
but at the end of that period I was done with Uworld once complete and my firs t aid contained
all important info in one book I was curious where I stood but I knew its still premature stage
so just did NBME 1 got 244 (174/200) not happy but felt confident to move on as I knew I
havent revised anything yet Resources I used are mentioned later in this article
Phase 2
Then began phase 2 where I started revising up the Consolidated first aid and also revising up
Uworld random timed mode but then realized after doing 40% of Uworld that doing the same
ques again wasnt really helping me learn more because I already knew the concepts n it was
just about memory recall so I left Uworld and never returned to it I felt doing Uworld once well
with consolidating first aid was more than enough to learn concepts so I began doing usmle rx
daily 50-100 qs in the morning n rest of day revising up the first aid it took me over a month to
revise up the first aid completely n during that time I did half of usmlerx too besides redoing 40%
of Uworld ques
This phase was the most difficult for me because I was learning anything new just revising stuff
so got really boring also I anticipated I would be over with it in 2 -3 weeks but it stretched to 5
weeks So I was freaked out literally in the mid-way I was so frustrated that one night I gave
NBME 7 got 251 (179/200) felt better because I knew its only going to rise up
B l og : i a mja g ji t.wordpres s .c om
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So after finishing up this phase I did NBME 11 n Score got better 255 (182/200) then next day
did UWSA 1 online and got 263 (770 - 83% correct) That was morale boosting I booked the
date of 4 weeks later as I felt thats enough time I would need for phase 3 (the last phase) of my
preps
Phase 3
During this phase I did all NBMEs every few days and was revising up the chapters which
UWSA1 showed as weak I was also trying to do USMLERx but then I just left it after doing
2/3rd because I wanted to do Kaplan qbank as many who got high scores have done it It was
about 3 weeks from exam I was doing old nbmes but my scores had plateaued now not rising
up I was frustrated coz I felt I was still not where I wanted to be esp. when I know the newer
NBMEs would be much harder than this Also, I felt I was hardly able to finish up the questions
on time At that moment 3 weeks from my exam I took a drastic step I bought Kaplan online
and started doing 8 blocks daily timed random exam style mode n then used to see the wrong
answers explanations in the remaining time of the day It was harder than USMLERx I got all
percentages from 70-89%... after 3-4 days I was done with 2/3 rd of it with 81% overall score
(against 61% avg) Then I gave completed all old NBMEs as exam was getting close n I wanted
to leave last week for one final revision scores were still in the same range but I was able to
finish blocks in 50 min so I literally trained my brain to think fast and right Also I was initially
making many silly mistakes due to lack of concentrations I decreased them as I moved on So
although the scores were still the same I knew I was improving daily by the end of that week
(i.e. 10 days from exam) I was done with 2/3 rd Kaplan n all NBMEs except 12 13 15 n 16 Then
I did UWSA2 online n scored 265 (800 - 85% correct) then did NBME 12 N 13 over next two
days got good scores In the last week I tried working on my weak areas shown in UWSA2
but it was increasingly getting difficult I was reaching saturation point then 3 days from exam
I decided to sit for NBME 16 online followed by NBME 15 That day I got the shock NBME 16
was 251 (179/200) I was shocked to the core n furious As it was the lowest I got in all nbmes
I was down thru the day so didnt do NBME 15 but by the evening I was so furious that I
decided to be done with NBME 15 the only assessment left I finished up by 12 midnight I
remember I was so tired I was dizzy n clouded through last two blocks But still I persisted I
was back to 262 (187/200) That was the relief I needed after that in last 3 days I was at
peace tried to revise a lot but still lot of revision was left undone
My Assessment scores...
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UWORLD - 76% (First time, subject-wise)

KAPLAN (finished 2/3rd) - 81% (Random, timed mode)
USMLERx (finished 2/3rd) - 85% approx
NBME 1 :
244 (174/200) 2 month from exam
NBME 7 :
251 (179/200) 7 weeks from exam
NBME 11 :
255 (182/200) 4 weeks from exam
UWSA 1 :
263 (770 - 83% correct) 4 weeks from exam
NBME 2 :
262 (187/200) 19 days from exam
NBME 3 :
258 (184/200) 18 days from exam
NBME 4 :
262 (187/200) 12 days from exam
NBME 5 :
259 (185/200) 11 days from exam
NBME 6 :
260 (186/200) 10 days from exam
UWSA 2 :
265 (800 - 85% correct) 9 days from exam
NBME 12 :
258 (184/200) 7 days from exam
NBME 13 :
NBME 16 :
NBME 15 :
Actual Exam score: 253

So, in a way, NBME 16 was closest in assessing and UWSAs n other previous NBMEs over predicted... Although I still holds that above 250, it varies according to luck and it becomes a major
factor...
Night before Exam

That was the worst night possible for me I had to travel over 2 hrs in morning to reach centre
so I had to wake up at 4 Therefore, I decided to sleep at 8pm and get 8 hrs sleep As it happens
always in usmle journey nothing goes according to plan I couldnt get to bed till 9 pm n even
then I tried tried n tried but couldnt sleep till 2am My heart was pounding and I knew I was
having panic attack and it was serious coz not getting good sleep before exam totally screw
up the exam irrespective of ur knowledge coz its more about thinking So I reluctantly to ok one
Levocetrizine as I felt it will have least hangover effect next day and still may help in sleeping
process (Although LCZ is 2 nd gen but still it has some sedation side effect not like fexofenadine)
I could hardly sleep by 2am
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I woke up at 4am got ready I saw in the mirror and told myself that despite all that happened
its all past For next 12 hrs I am going to give my best and wont let anything affect it I realized
life always puts you through troubles to test your inner strength and deter mination and its up to
you Either you can keep making excuses and blame others for ur failures, or you can stand up
against all odds and win the day despite all resistance I had made up my mind I travelled 2 n
half hours to reach centre It was extremely cold n foggy (those who r from Delhi know how it is
early morning in December end) I didnt revised anything during the travel I felt it will only
make things worse so kept my mind free remembered my god and went for it
Exam experience
I started at 8 A good friend who already gave the exam told me previous day that expect the
worst in the exam and u wont panic I was also told that exam is very lengthy n u will not get
time to review marked ques even So with all these preoccupations I started my first block It
was average not really difficult got done with all ques with about 12 -13 mins left n then
reviewed all marked n then saw all the answers just to make sure I didnt accidently clicked the
wrong option (such thing can happen) I was totally calm and no panic or tension after finishing
1st block I felt I got into my zone when u r ready to face anything without tension or worry of
whether u wil get it right or not u just have to give the best u can choose what option u feel is
right there is nothing else we can do so why worry I had totally free mind n from there on
the whole exam was like that I took toilet break after each block n also rinsed my face with
water n had some glucose water by end of 4 th block I felt hungry so took a big break of 20
min n had some Rajma Rice apart from that only thing I ate during exam was an apple after
6th block I think just to get some energy for last push about difficult levels.. As expected it
increases with each block 4 th n 5th block were really difficult 5 th was most so many weird ques
but I persisted tried my best... by 6 th n 7th block I was ready for anything having already seen
the most difficult ques Overall it was great experience I was able to maintain concentration at
100% thru out no dizzy episode or cloudiness My endorphins were flowing high in my brain
(the same mechanism why soldiers in battlefield do not feel much pain) I completed the final
block and was done
How was exam?

Pattern : Its most similar to NBME form 16 which had many weird questions only difference was
that it had very few 2-3 liners n much larger proportion of those weird questions
Difficulty: Its doable thats something everyone who gives exam agrees Expect the worst and
you wont really panic but if u r going into exam expecting all things to come from book u r
going to have shock Although about 80% of the exam is from common diseases and topics
mentioned in first aid n Uworld its different They will ask very simple info but will twist the
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question a lot so that if u do not pay 100% attention while reading the ques u tend to miss very
important info needed to answer correctly also they will lure u will many attractive options who
will look more likely and only if u have strong concepts u will not get distracted from right answer
Rest 20% ques is like from somewhere else u cannot prepare for it n when u see them u
just use all ur basic concepts and reasoning skills to come to the most appropriate lookin g answer
and then click it n move on dont let that ques make u panic or tensed its the same for
everyone remember that Just trust ur instincts on those and there is nothing much u can do
People say that its the most difficult exam more than any qbank or nbmes its true coz it
has such large proportion of weird out of the book questions but if u understand biostats you
must know that you are being evaluated against a standard curve
For example suppose u get an easy questions block u score 80 % in it but mean score on
that is 75%... so u r only marginally better than mean so ur score wont b that good but if u get
a difficult set with mean score of 60% n u get 75% in it u will get much high marks because u
r lying way above on curve Thats the reason that despite the fact that real exam has so many
weird questions while nbmes mostly have simple easy questions still scores in both r generally
similar coz no matter which exam you give based on your basic concepts strength u will lie
in similar range over the general curve so ur marks doesnt change in simple words u dont
need to get over 92% questions right on exam to score 260 like u need to do for nbmes so no
need to panic just do the best you can on that day and leave the rest to luck
Whats more tested: Its a mix bag and really you shouldnt deal with this exam this way Always
think each n every subject is important coz even if there r only 10 ques of a particular subject
they hold the power to affect ur score a lot so always focus on excelling all the subjects In my
exam there were not a lot of anatomy weird questions (a few were there but tolerable), not a lot of
incontinence ques (hardly 2-3 I think), not lot of images (but many of them were weird and some
were really difficult but mostly u can make something out of stem and get to a reasonable
answer) there were two heart sounds and two ecgs all four were easy but in heart sounds
there was nothing in stem so u got to identify the sound to answer them CT/MRI I had few
one of them was really difficult other were fine
Length of questions: I had a mix bag there too mostly questions were like 5-10 lines long some
were long so long that u got to scroll down but mostly they were long coz of lots of unnecessary
labs given U must be good at reading the labs quickly n highlight only those which r relevant to
the ques this way u can deal with such ques I got many 3 2-3 liners too Overall it wasnt that
scary as many others said in their experiences May b I got lucky or something
Timing : I had enough time to finish up all blocks with about 6-10 min spared to review all marked
ones n then quickly go thru all ques to check I marked the right options so time wasnt an issue
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Breaks : I had done online tutorial beforehand so I just checked headphones n quickly went thru
rest of tutorial the interface is mostly similar to Uworld so u wont really have trouble dealing
with it I finished tutorial in 2 min so I was left with 58 min of breaks I used them in the
following order
Block 1 -> 3-4 min break (went to washroom n rinsed face with water, then drank some water and
went back)
Block 2 -> 3-4 min break (went to washroom n rinsed face with water, then drank some water and
went back)
Block 3 -> 5 min break (went to washroom just to wash face and stood there in power pose for 1
min to energize myself then went back)
Block 4 -> 20 min break (I was feeling hungry so decided to take a lunch break went to
washroom n then washed face n then had some Rajma rice I got fro m home n then some
glucose water)
Block 5 -> 14 min break (I was left with about 28 mins of break n just two breaks to take so took a
lot of time also as Block 5 was the most difficult block I faced I needed some time to recover
again went to washroom... no no I dont have diabetes inspidus but I made sure I dont feel
peeing in middle of block :P after washing face n having some glucose water I went back)
Block 6 -> 14 min break (I was relaxed n happy as only one block left just again did routine o f
going to washroom n washing face had some apple for energy n then went back sat on seat
for two min n then clicked start new block)
Block 7 -> over n done
Any step 2ck type ques : a few what will b next step type ques were there but can be done wit h
step 1 knowledge n some common sense no extra knowledge required
New topics: There will always be some weird diseases being asked which will not be found in first
aid n Uworld but thats a part of game I cannot share the questions obviously but I wo uld
anyway advise to focus on whats there in first aid n Uworld n do them well instead of worrying
about a few new topics which will not find in any textbook
Subject wise patterns in exam:
Gross Anatomy: Some weird ques were expected but not many were there hardly around 5
ques n mostly u cud reach to a reasonable answer so dont worry about them a lot
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Embryology: I think its pretty easy on exam just make sure u do understand hedgehog,
homeobox, fgfr, wnt pathways n their roles in embryo well coz they r really high yield... although I
didnt encounter any ques on them on my exam
Histology: Basic histology isnt that much tested on exam mostly its pathology related histo
but u must have an idea of how normal tissues in different body systems look like on section I
wasnt really good at histo but I think doing pathoma n goljan really helped me got better at it
I didnt do webpath n other sources which people highly recommend coz never had time for
them)
Neuroanatomy: Very high yield and scoring too make sure u understand it well also do all the
brain sections n arteriograms given in HY neuroanatomy
Physiology: One of the trickiest subject on exam lots of up n down arrows and they r risky
coz if u mess up with one parameter whole ques gets wrong
Biochemistry: it wasnt really difficult in my exam most of ques were easy a few were tricky
but still nothing out of the book there
Molecular biology: I got some really weird n totally out of all the books type ques on exam on this
subject and I have no idea how can anybody prepare for them Just do molecular biology n
genetics well and hope for the best nothing much can be done about it really
Genetics : This was pretty easy some simple calculations there might be 1-2 difficult ques
but not more than that but its scoring so make sure u dont lose ur marks here
Pathology: It obviously was all there everywhere mixed with other subjects Mostly doable and
ques were from the topics mentioned in first aid n Uworld but I got 4 -5 difficult ques on strange
diseasesn I couldnt make diagnoses in 2-3 I guess but still made the most reasonable guess
and moved on in exam u will find such ques just make sure they dont affect ur thinking process
on other ques and also u never know which ques are just experimental so just make sure u
do ur best This subject is really important because in most of questions u will b given a patient
scenario n first and foremost step to answer a ques rightly is to make the right diagnosis so
no matter what subject they r testing u need basic knowledge of pathology before moving on to
what is being asked that is the reason I find doing both pathoma n goljan worthwhile coz its such
an important subject that u cannot think of shortcuts just cannot
Microbiology : People asked me whether there are any preventive medicine ques in exam thats
where they were so must do modes of transmission of all infections well coz that is quite
tested also there were many difficult images in this subject on my exam My micro was never
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the strongest n having such ques made things worse But still its doable Remember all
microbes even the minutest ones which u might think that they will never be tested u can
have just any microbe mentioned in first aid Uworld sometimes they ask the treatments of
infections too so correlate them well like after u complete anti-microbials chapter go back to
microbes and see which antibiotics/antifungal/antiprotozoal/antiviral is preferred for which
microbe thats pretty high yield Some skin infections images were also there in exam so
make sure u learn to identify infections by looking at them
Immunology : Apart from molecular bio this was also another section on exam filled with many
weird ques which test urn basic concepts of the immune to the core so make sure u understand
mechanisms well and which immune mechanism will come into action when like they can give
a patient scenario n ask which immune mediator is working like that Mostly I was able to tackle
it well
Pharmacology: Mostly were easy ques make sure u do all the side effects and drug interactions
well and also do cyp 450 enzyme types well which is given in Kaplan overall it wasnt really
difficult n doable
Behavioral science : I used dr.daugherty lectures n brs as I mentioned later n I found it quite
sufficient to tackle all the questions on exam nothing really difficult
Biostats: One of the easiest section on exam I was good at maths so calculations really didnt
bother me and they were mostly easy some were testing basic concepts... nothing that was
out of book or weird easy stuff there
Ethics: Mostly easy questions not a lot tricky its the trickiest section of exam but I got lucky
to have got good ques there I was able to reach one best answer in all As I mentioned later
I didnt do Khans or Fischers cases but it didnt affect me
Multimedia : Many images were there which I havent seen anywhere and for many I was quite
clueless too but mostly stem helps u get to a diagnosis so concentrate on basics
Heart sounds : two in my exam both were like u got to identify and nothing in the stem so
practice them well there is an app on android heart sounds n murmur search it n download it
its sounds r mostly similar to what are there on exam
ECG: there were 2 pretty easy from first aid I would like to give a list of ecgs u must be
familiar with when appearing for exam as they r high yield it goes like this:
Atrial fibrillation
Ventricular fibrillation
Torsades de pointes
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WPW syndrome
Brugada syndrome
Heart blocks (first second n third degree with both mobitz type1 n 2 for second degree)
Hyperkalemia n hypokalemia
Pericarditis
ST elevation MI (must know which leads are for Anterior, lateral n inferior)
CT/MRI: practice them well there r some difficult ques there so must be good at them use
any resource u can to practice them HY Gross anatomy has many sections n they will really help
u get hold of it.
Resources I used (Assume FA is for everything coz I

consolidated everything into it)
Gross Anatomy: Kaplan + High Yield (Did it well as Kaplan is basically nonexistent in this
department)
Embryology: Kaplan + High Yield (Really nice book I think its a must to master embryo on
usmle)
Histology: Kaplan + High Yield (Just skimmed through it n saw pics at the end the text is too
detailed and really not that high yield :P)
Neuroanatomy : Kaplan + High Yield (I personally liked Kaplan more but still felt High yield
complemented it nicely esp. HY has a chapter focusing on brain mri/CT n all arteriograms
these r real high yield topics and thats why I think its a must)
Physiology: Kaplan + BRS Physio (I liked both While Kaplan teaches concepts it gives info
very vaguely on the other hand BRS physio gives exact info I esp. liked the tables given of
parameters going up n down in each diseases thats very important as on real exam many
physio ques are like that also BRS physio has Neurophysio which is not present in Kaplan and
it is high yield for exam like I saw many ques on type of nerve fibers and skin receptors on
nbmes)
Biochemistry: Kaplan (I tried starting Rapid review but felt it was too much and really I understood
the metabolism really well from Kaplan so never felt need to go for another book)
Genetics: Kaplan (I understand the person in lectures was too slow n boring but he taught some
really important topics nicely be patient n u will gain a lot)
Molecular biology: Kaplan + High Yield (I studied it with Genetics because both complements
each other HY has many nice chapters esp. there is chapter on Molecular techniques
teaches u those techniques very well also it all the molecular pathways of MAP kinase PI3K
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10
Smad etc n u must know them as just knowing Gprotein coupled mechanisms n Jakstat will not
be enough for exam I also googled to learn WNT pathway n Sonic hedgehog pathway as they
are high yield and not mentioned anywhere These molecular mechanisms and molecular biology
techniques are totally missing from first aid I dont know why so... hopefully they will be added
in future)
Pathology: Pathoma + Goljan Big book 4 th edition (I started with Pathoma videos combined with
notes did them once They explain pathology concepts really nicely Some people asked if
notes are enough I would highly recommend doing videos with notes as Dr. Sattar draws lot of
handmade diagrams to make u understand things and u can even draw them in ur notes for
revising up later quite useful for creating a good base After doing Pathoma I started doing
Goljan big book having already done Pathoma really made Goljan more tolerable coz
otherwise its a very tough book to do There are audios n other notes available too but I felt
nothing compares to the big book it takes u to the next level u start understanding diseases
like u never did before General pathology chapters given in goljan are the best part of the book
and must not be missed Esp. chapters like environmental these are not given anywhere else
so pretty useful J I am glad I did it but I took it one step ahead and consolidated the whole
goljan into first aid this ensured that I never had to go back to it which sa ved a lot of time in
last 2 months)
Microbiology : Kaplan (Also tried doing Lippincott microcards n clinical micro made ridiculously
simple but felt it was too much the info u get in Kaplan n first aid was more than enough and u
just need to understand n remember them well )
Immunology: Kaplan (Nothing else needed really if u listen carefully to her she explained
immuno such nicely)
Pharmacology : Kaplan (I couldnt think of a better source so just followed Kaplan n I felt Kaplan
+ first aid was more than enough for pharma)
Behavioral science : Dr. Daugherty lectures + BRS behavioral (Did them both together chapter
wise I felt that was the best combination possible first listen to the lecture on a chapter with
lecture notes then do BRS chapter on that topic n follow it up with questions given in BRS at
the end of chapter that way u will understand the concept really well Also, BRS has chapters
like one chapter on insurance which was not mentioned anywhere but is quite high yield nowadays)
Biostats: Dr. Daugherty lectures with notes followed by UWorld biostats review questions (Do
these well and you will sail through biostats easily Also somebody asked so clearing it
UWorld biostats review section questions are different from the biostats ques i n uworld qbank
so it ensures u do about 100+ ques on biostats good enough for preps)
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Ethics: Dr. Daugherty explained it really nicely n followed it up with First aid never felt the
need to do anything else So didnt do Fischers cases n Khans cases so cannot comment on
their effectiveness do them if u feel u dont understand these type of ques well
Qbanks
Uworld
No doubt its the best out there and not just because of difficult n tricky questions but also due
to its good explanations so dont skip the explanations do them well and note down important
points in first aid
Kaplan
I would keep it second in number after uworld although it is more based on memorizing minor
details but its a good test of how much u remember from the book n has some really nice
questions too worth doing
USMLERx
It was good but easier than other two dont really test ur skills that much but has some nice tricks
u would want to learn for exam apart from that I does add extra points to first aid not exactly
a complete repeat of first aid like it mentions lot of info about a topic which is not mentioned in
first aid so dont think its just first aid but only do it if u r done with Uworld n Kaplan I realized
it pretty late but still no regrets
IDEAL STUDY PLAN

Although there is nothing like ideal study plan as each person is different and has unique style of
studying from my experience I felt if I was asked to rewind and do the whole journey again
I would have planned it this way But again thats what I felt I would have liked to do everybody
is different
Phase 1: Building base

Estimated time: 4-6 months
No matter how much people say do Uworld n first aid later I found them most useful doing after
each subject coz that is the time when u r totally fresh with all the info of that subject n so u
must consolidate first aid n do Uworld questions at that time only later u will forget things n it will
never be the same again
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12
So start from basics I recommend starting from Anatomy physio coz they r the most b asic
subjects and if u r not strong in them u cannot get hold of pathology later so start subject wise
in following order:
Anatomy -> Physio -> Biochemistry (do genetics n molecular together) -> Micro & immune ->
Pathology -> Pharma -> Behavioral & Biostats
For each this would be the order of books/qbanks:
Kaplan (videos + notes) -> Reference book -> First aid (consolidate all important into first aid) ->
subject wise Uworld questions on that subject
In this phase only aim is to understand all the concepts u may forget many details but its
fine u will get to that later right now concepts is utmost important I can never overemphasize
the importance of this phase its so important that if u screw this up u can never reach those
higher scores so u must take it very seriously
We all have lots of holes in our concepts and USMLE likes to exploit them to the best so make
sure u fill all the holes in there During this phase what helped me most in f illing those holes were
Goljan big book, Uworld explanations and Google these three sources answered most of my
why n how.
Make sure u understand the mechanisms behind facts very well thats really important for step
1 as somebody said Depth is more important than shallow breadth
About consolidating First aid, I spiral bound my first aid then removed spiral binding n put the
first aid into binder folder so that I can easily add pages in between then I got an A4 sheets
bundle holed for spiral binding n used those sheets to add wherever required in first aid Also
there is lot of empty spaces in first aid which u can use to max at the end of this phase u will
have all material in one thick book nothing better than that then I took out the first a id and respiral binded it in two parts (coz it was too thick for one) and that became my ultimate bible for step
1
Phase 2: Revision n memorization

Estimated time: 1 1.5 month
This phase is to revise up the consolidated first aid and do Kaplan qbank alo ngside daily do it
like this 2 blocks daily morning followed by looking at explanations n adding extra info into first
aid then use rest of day for revision Also if possible u must do one oldest nbme each Sunday
so that way u can get thru those initial nbmes 1-6
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Phase 3: Getting ready for the final battle

Estimated time: 1 month
Give one online nbme at the start of this phase if u r in +/- 10 range of ur target score book a
slot of 1 month later Now in this phase the goal is to finish up all remaining nbmes at regular
intervals n do revisions in between hopefully u will be seeing growth in each exam concentrate
on ur weak areas make them stronger Also, I would recommend doing both uwsa as they r
really nice uworld ques and have good explanations they got some info which was not mentioned
in qbank even so pretty useful stuff there
If u feel like doing more questions u can do usmlerx not really high yield but good for practice
For nbmes I would say do 2 nbmes back to back on same day each Sunday this way u would
be training ur brain to think fast n answer continuously for 8 hrs really matters a lot in exam I
would advise doing nbme 16 n 15 on same day n keep it 1 -2 weeks before exam coz by that
time u will b ready prep wise n nbme 16 generally underpredict ur score so u must give it with
another nbme (nbme 15 is closest) to prevent ur morale from going down In last week u can just
thru those areas which require lot of memorization n little concepts like biochem, micro, general
pathology, general pharmacology n all the pharma at the back of each chapter these are thi ngs
which u got to memorize
In the end even on the last day there will be lots of things which u will be forgetting here is a
list of forgettables u must see once on last day
Lysosomal storage disorders
Upper limb nerves
Lower limb nerves
Glycogen storage disorders
Vitamins deficiencies
Drugs of abuse
CD molecules and the significance of each
Tumor suppressor genes
Oncogenic Translocations
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14
G protein receptors types and hormone examples

Diffusion limited versus perfusion limited
Steroid synthesis and adrenal cortex pathways
Exotoxins
Streptococci and Staphylococci characteristics
Antibiotic mechanism of actions
Rickettsia
Parasites (all of them)
Leukocyte/endothelium interaction
Sleep stages with their EEG changes
Hemoglobin synthesis pathway and porphyria
MEN Types
Cardiomyopathy types
Teratogenic drugs
Muscarinic and Adrenergic lists
The glomerulonephritis histopathologic changes
Bone tumors
Leukemias
List of Drug Inducers and Inhibitors
HLA Associations
Hypothalamic nuclei
List of antivirals and their mode of action
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15
List of viral classes and their exceptions

Purines and Pyrimidines pathways
Monoclonal antibodies and anticancer drugs
Autoantibodies
CD counts landmarks in HIV infection
Pharyngeal arches and pouches and their derivatives
Antiarrhythmics classes
Pharmacology equations
Lipoprotein pathways and metabolism
Child developmental milestones
Immunodeficiencies
All the formulas
Also, go through all the images u might have saved through these long months finish up
everything by evening n relax dont do anything after that although its true that u cannot
remember everything n u will tend to forget things trust urself that u kn ow enough to tackle this
beast I hardly remembered 60% of my first aid at the time of exam but its fine coz exam
doesnt test u that way it tests concepts which r long-wired into ur brain through these months
there will be very few recall type ques So relax be excited coz in next 24 hrs u will be done
with one of the most difficult exams in medical field in the world and that also with dignity nothing
can compare to that feeling so embrace it n give ur best on the day Sleep well (although I
couldnt but its importance cannot be undermined) Good luck for the day
FAQs (Frequently asked questions)

Q1. How many questions u believe we're directly from FA and Uworld?
A1. Exact questions will never get repeated obviously but the concepts always do I believe
around 70-80% of exam is based on basic concepts discussed in Uworld first aid n Kaplan for
rest u can read as much as possible but still there will b question out of everythingn u can only
make calculated guesses for them
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16
Q2. they say that exams more difficult than nbme (15 / 16) so how does nbme assess us?
A2. Because as I already explained its about curve ur performance is judged against a curve
which will obviously vary according to the difficulty level more difficult the exam lower will be
the curve against which u will b assessed thats why nbme assess us well
Q3. Is pathoma+goljan enough for step 1?? What would u prefer?? Goljan or pathoma? Are
pathoma and FA enough for patho??
A3. I did both and found it a nice combination doing one of them is dicey coz its such an
important such which is all around everywhere in the exam so u got to be good at it to score well
Q4. What about anatomy?? Is Kaplan and FA enough? FA Kaplan lec n videos enough for
anatomy, embryo, histo and cell biology? How was ur experience?
A4. I did High yields for all subsections of anatomy as I found Kaplan n first aid both highly
incomplete in this department but trust me even high yields wont complete that knowledge
coz mostly the weird ques are from outside everything they will test ur basic understanding of
human body in a very peculiar way that cannot be covered by any book.
Q5. How to start NBME? Best time to start it?
A5. Start doing nbmes when u r done with all syllabus n revised everything at least on ce coz
they r more memory based ideally in the last 1.5 months before exam
Q6. How many questions from anatomy in an average?
A6. not too many around 10-15 I guess not a lot of them as many told.
Q7. if strong in biostat, so you think that will that give an edge too score higher?
A7. Anything u r strong in will get u to higher score so aim to be strong in every subject ideally
u r able to get a star in each subject ur score comes in the range of 260 on nbmes Biostat was
relatively easy in my exam but I was always good in calculations so that helped may be.
Q8. plz tell average percentage of q from each subject?
A8. its hard to predict also everybody has different questions set only surety is that majority
will be pathology or pathophysiology but its important to do all subjects well
Q9. Can u guide us abt where to annotate? I am using Kaplan goljan Uworld and FA... How to
manage all sources at the end?
P a g e 16 | 21
17
A9. About consolidating First aid, I spiral bound my first aid then removed spiral binding n put
the first aid into binder folder so that I can easily add pages in between then I got an A4 sheets
bundle holed for spiral binding n used those sheets to add wherever required in first aid Also
there is lot of empty spaces in first aid which u can use to max at the end of this phase u will
have all material in one thick book nothing better than that then I took out the first aid and re spiral binded it in two parts (coz it was too thick for one) and that became my ultimate bible for step
1
Q10. If we failed to diagnose the case (ques) we go for elimination method. Please help how
cleverly to eliminate the other options with in time limit..???
A10. Yes that happens many times If u r not able to come to a diagnosis or answer
straightaway u got too look at the options n immediately strike out the options which r obviously
wrong for that what I did was just start seeing each option one by one n ask one ques to
urself can this be the right answer if u feel it cannot be just strike it off if u fe el it can be
then keep it this way u will come down to 2-3 options now among them look for info given in
stem like u know there should be hypokalemia in hyperaldosteronism so look at lab values
if potassium is normal or high obviously its not the right option.. like this example search for
clues in the stem which will help u selecting the best answer among the 2 -3 shortlisted options
Now there is also a concern that if ques is long how to go back to it n read it again what I did
was I used to highlight important words as I was reading the ques this way if I had to go thru it
again to look for clues I would just have to look at highlighted text similarly in labs if there
are lot of labs given quickly highlight those which r not normal as u r r eading them this way u
wont have to go thru them againn it will help u make correlations also like if u calcium is low n
albumin is low in the labs.. u know calcium is normal in this patient just coz albumin is low thats
y its coming low in labs so this way it helps a lot
Q11. is the questions tougher than usmle world q bank??? Any Outside or latest topics asked???
A11. Its different exam do not give lot of clues or info in stem to answer a ques so u got to
pick the few clues given in the stem while in Uworld there r lot more clues so that way it
becomes difficult also most of the times exam asks basic concepts n diseases.. but twist the
question stem in such a way that if u r not 100% attentive while reading u may miss the most
important clue n get ur answer wrong or sometimes they fill the options with so many attractive
diseases that it will try its best to lure u to wrong answer thats y u need strong concepts to
stick to right answer while the examiner will be trying its best to distract u towards the wrong
answer
P a g e 17 | 21
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Q12. Were the questions lengthy and had irrelevant details? As most of people saying that
question stems are lengthier than UW etc.
A12. Questions were mix bag some were lengthy some were 2-3 liners also avg was about 810 lines not more than that.
Q13. How was the pattern? Was it like Uworld and nbmes or different? esp. behavioral sciences
and biostatistics? How many Q of Bs per block approx.?
A13. Pattern is most similar to nbme 16 with lot more proportion of weird questions about
behavioral n biostats pretty doable n easier stuff not many difficult questions there I didnt
count them but not too many may b 3-4 per block or less
Q14. no of images per block gross and histo pictures?
A14. Not too many I expected a lot of them after listening to others experiences but not a lot
may be about 15 per block or so I was prepared to see images every ques so I didnt panic at
all seeing them
Q15. How much time is enough (months) and how many hours in a day??
A15. I took about 7-8 months with about 8-10 hrs in first 5 months n about 10-12 hrs in next
1.5 months towards the end I was clocking about 15 hrs a day time pressure makes u do
everything :P
Q16. What sort of anatomy questions you got? Was it close to NBMEs?
A16. Anatomy is always weird but thats a part of game luckily not too many weird ques just
few to take u off the track but u must keep going
Q17. any qs on preventive medicine?
A17. As I mentioned mostly in micro part u must know the modes of transmission well n what
prophylaxis can be given in what situation like that I didnt get any sterilization type ques but
they r high yield
Q18. Ur experience with ur paper?
A18. felt good I know I didnt know answer to many of them... but its obvious u cannot be
perfect there all u can do is believe in urself and select the answers which u think best solves
the problem given
P a g e 18 | 21
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Q19.how many time did u do uworld + FA + Kaplan videos and lect notes?
A19. Never counted as I used to see difficult topics more times than other topics overall may b
3-4 times
Q20. what NBME did you do, and what were your scores?
A20. All nbmes n uwsa scores were good once I will get my real score I will update the post
with my all scores
Q21. What is the best QBank to start with the preparation?
A21. I believe Uworld because its so important in ur preps for exam that u dont want to delay it till
the end the sooner u start doing it the better it is for ur preps thats y I recommend using it as
first qbank People say that u must do it closer to exam but I dont think thats a good choice
coz exam ques r not like Uworld so anyways it doesnt matter u remember ques or not but
concepts will stay with u In my case I didnt touch Uworld again in last 2 months n still never
had problem
Q22. Qs u couldnt solve to which topics it were related?
A22. God knows :P coz they r totally out of all books they r the ones u cannot prepare f or
ever u can just guess n luck will do the rest so prepare all u can but be prepared to face
such ques they will be there always
Q23. Jags I read that u annotated the whole goljan into FA. .but if u could, tell us if majority of what
u annotated is an elaboration of what is there in FA. ..or totally new concepts...if possible subject
wise. That way we could know. How far beyond FA should we read?
A24. Mostly reasoning to the facts written in first aid but yea lot of new concepts or topics
too like I mentioned molecular techniques n molecular signaling pathways were not mentioned
in first aid but are high yield....similarly goljan big book general pathology chapters had many info
which was not anywhere n was important so more u read the better it is that y I chose to do
Kaplan n one more reference book for most subjects first aid is very basic n not at all sufficient
for exam.. its only good for final revision when u cannot revise up all the subject books thats it
or u can do what I did n consolidate it from all sources n make it comprehensive to include all info
then it becomes sufficient
Q25. I want to score 270+... so tell me the pressure points where u felt that mistakes should be
avoided? If there is a single most important thing to score 2 70+ whats it according to you?
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A25. Single most important thing is belief in urself aiming for 270+ is a very brave decision... but
u must back it up with proper planning n hard work I am a person who always believed that fate
is in our hands but by the end of the journey I realized that its true up to 250s beyond 250s
u need luck more lucky u r, higher u will score coz only a few ques make the difference
between 260 n 270 So to score 270+ u need to be brilliant n master at all subjects n besides
these u also need lot of luck there r many questions on exam which r totally out of books n no
matter how much u have studied u r rely on ur IQ reasoning n luck to get them right
Q26. Is Uworld qbank enough for questions or will doing Kaplan qbank help ?
A26. simple funda more questions u practice better ur chances of scoring high becomes
coz ur mind gets trained to think fast n right in time pressure situation
Q27. How many times should I repeat Uworld questions?
A27. I did once Uworld subject wise I tried repeating it in random timed mode but left it after
40% coz I wasnt really gaining much from revision
Q28. Is Kaplan notes for micro and immune good? Coz its too much and extensive
A28. they are extensive but they r good n must for exam as exam can ask about just any obsolete
or smallest least important microbe dont think u will only get strep staph in exam so u must
be good with all microbes
Q29. I have almost done with Rx Qmax (may be few more days it will take). I have not started
Uworld. As I am already done with USMLE Rx. I think I will do u world very fast. Is it alright to do
Uworld fast??
A29. just start Uworld as soon as u can... n dont neglect its explanations... read each n every word
of explanations carefully n note down important points into first aid... it might take up to a month n
plz... do not ignore the explanations... thats where the power of Uworld is...
Q30. As I have started first year in a medical school what would recommend me as I want to appear
in USMLE Step 1 in 3rd year? And should I start reading first aid now? Or watching Kaplan videos?
A30. concentrate on knowing why n hows of everything... knowing what is not enough... for
example u will read sepsis can lead to ARDS... but u must know how it does... only then its
complete info... focus on basics...
Q31. my exam is soon can help me regarding exam what should I do? means reading or UW OR
NBME?
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A31. do all the nbmes all 12 n both uwsa exams... concepts do get repeated... someti mes images
too... although questions were different but it helps...
Q32. How do u advise to do UW: Subject wise or overall random?
A32. I believe first time u must do it subject wise along with the subject u just did thats the best
time to grasp max. concepts from it rest u can decide better
Hopefully, this comprehensive review will help many and answer many queries I tried my best
please don't ask me regarding what questions came on exam.. as I cannot share it with anyone...
that's illegal and obviously I won't do that... if u still got queries feel free to ask Good luck for
ur preps n exam Its a tough road but trust me its worth it U will not only come out with a
good step 1 score u will be a better person and a better doctor
Bleed now so you may rejoice later
Dr. Jagjit Khosla (Jags)

You can follow me at following links :
https://iamjagjit.wordpress.com/
https://www.facebook.com/drjagjitkhosla
P a g e 21 | 21

Step 1 USMLE Do It Like You Own It (Road To 253)

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Step 1 USMLE Do It Like You Own It (Road To 253)

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Step 1 USMLE: Do it like you own it (Road to 253)

UWORLD - 76% (First time, subject-wise)

244 (174/200) 2 month from exam

251 (179/200) 7 weeks from exam

255 (182/200) 4 weeks from exam

263 (770 - 83% correct) 4 weeks from exam

262 (187/200) 19 days from exam

258 (184/200) 18 days from exam

262 (187/200) 12 days from exam

259 (185/200) 11 days from exam

260 (186/200) 10 days from exam

265 (800 - 85% correct) 9 days from exam

258 (184/200) 7 days from exam

256 (183/200) 6 days from exam

251 (179/200) 4 days from exam

262 (187/200) 3 days from exam

Actual Exam score: 253

Night before Exam

How was exam?

Resources I used (Assume FA is for everything coz I

IDEAL STUDY PLAN

Phase 1: Building base

Phase 2: Revision n memorization

Phase 3: Getting ready for the final battle

G protein receptors types and hormone examples

List of viral classes and their exceptions

FAQs (Frequently asked questions)

Dr. Jagjit Khosla (Jags)

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