step 1 usmle do it like you own it (road to 253)

B l o g : i a m j a g j i t . w o r d p r e s s . c o m P a g e 1 | 21

1 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 that’s 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 it’s still premature stage…

so just did NBME 1… got 244 (174/200)… not happy but felt confident to move on as I knew I

haven’t 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 wasn’t 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 it’s only going to rise up…

https://iamjagjit.wordpress.com/



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 that’s 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 didn’t 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...



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





UWSA 2 : 265 (800 - 85% correct) 9 days from exam





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 couldn’t get to bed till 9 pm… n even

then… I tried tried n tried… but couldn’t 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 took one

Levocetrizine as I felt it will have least hangover effect next day… and still may help in sleeping

process… (Although LCZ is 2nd gen but still it has some sedation side effect… not like fexofenadine)

I could hardly sleep by 2am…



I woke up at 4am… got ready… I saw in the mirror and told myself that despite all that happened…

it’s all past… For next 12 hrs I am going to give my best and won’t let anything affect it… I realized

life always puts you through troubles to test your inner strength and determination… and it’s 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 didn’t 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 won’t 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 didn’t 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 5th 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: It’s doable… that’s something everyone who gives exam agrees… Expect the worst and

you won’t 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… it’s different… They will ask very simple info but will twist the



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 looking answer

and then click it n move on… don’t let that ques make u panic or tensed… it’s the same for

everyone… remember that… Just trust ur instincts on those and there is nothing much u can do…

People say that it’s the most difficult exam… more than any qbank or nbmes… it’s 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… That’s 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 doesn’t change… in simple words… u don’t

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…

What’s more tested: It’s a mix bag… and really you shouldn’t 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 wasn’t 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 wasn’t an issue…



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 won’t 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 from 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 don’t have diabetes inspidus… but I made sure I don’t 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 with

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 that’s a part of game… I cannot share the questions obviously… but I would

anyway advise to focus on what’s 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 don’t worry about them a lot



Embryology: I think it’s 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

didn’t encounter any ques on them on my exam

Histology: Basic histology isn’t 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

wasn’t really good at histo… but I think doing pathoma n goljan really helped me got better at it…

I didn’t 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 wasn’t 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 don’t 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

diseases…n I couldn’t 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 don’t 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 it’s 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… that’s

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



the strongest… n having such ques made things worse… But still it’s 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… that’s 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 wasn’t 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 didn’t

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… it’s 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 didn’t do Khans or Fischer’s cases… but it didn’t affect me…

Multimedia : Many images were there which I haven’t 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 Torsade’s de pointes



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 it’s 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 that’s why I think it’s 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… that’s 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



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 don’t 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 it’s 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 saved 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 couldn’t 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 in uworld qbank…

so it ensures u do about 100+ ques on biostats… good enough for preps)



Ethics: Dr. Daugherty explained it really nicely… n followed it up with First aid… never felt the

need to do anything else… So didn’t do Fischer’s cases n Khan’s cases… so cannot comment on

their effectiveness… do them if u feel u don’t understand these type of ques well…

Qbanks

Uworld

No doubt it’s the best out there… and not just because of difficult n tricky questions… but also due

to its good explanations… so don’t 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 it’s 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… don’t 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 don’t think it’s 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 that’s 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…



So start from basics… I recommend starting from Anatomy physio coz they r the most basic

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 it’s

fine… u will get to that later… right now concepts is utmost important… I can never overemphasize

the importance of this phase… it’s 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… that’s 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 re-

spiral 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 alongside 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



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 things

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



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



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… don’t do anything after that… although it’s true that u cannot

remember everything n u will tend to forget things… trust urself that u know enough to tackle this

beast… I hardly remembered 60% of my first aid at the time of exam… but its fine… coz exam

doesn’t 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

couldn’t 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 everything…n u can only

make calculated guesses for them



Q2. they say that exams more difficult than nbme (15 / 16) so how does nbme assess us?

A2. Because as I already explained… it’s 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… that’s 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 it’s 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. it’s hard to predict… also everybody has different questions set… only surety is that majority

will be pathology or pathophysiology… but it’s 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?



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 feel 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 it’s not the r ight 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 reading them… this way u

wont have to go thru them again…n 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 that’s

y it’s 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. It’s 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… that’s 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…



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 8-

10 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 didn’t

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 other’s experiences… but not a lot…

may be about 15 per block or so… I was prepared to see images every ques… so I didn’t 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 that’s 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 didn’t get any sterilization type ques… but

they r high yield…

Q18. Ur experience with ur paper?

A18. felt good… I know I didn’t know answer to many of them... but it’s 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…



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 it’s so important in ur preps for exam that u don’t want to delay it till

the end… the sooner u start doing it the better it is for ur preps… that’s y I recommend using it as

first qbank… People say that u must do it closer to exam… but I don’t think that’s a good choice

coz exam ques r not like Uworld so anyways it doesn’t matter u remember ques or not… but

concepts will stay with u… In my case… I didn’t touch Uworld again in last 2 months… n still never

had problem…

Q22. Qs u couldn’t 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 for

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… that’s 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 270+ what’s it according to you?



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 wasn’t really gaining much from revision

Q28. Is Kaplan notes for micro and immune good? Coz it’s 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… don’t 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 don’t 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... that’s 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 how’s 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?



A31. do all the nbmes all 12 n both uwsa exams... concepts do get repeated... sometimes 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… that’s 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… It’s a tough road but trust me… it’s 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://www.facebook.com/drjagjitkhosla


https://www.facebook.com/drjagjitkhosla

step 1 usmle do it like you own it (road to 253)

Documents

g j i t

preps phase

article phase

firs t aid

w o r d p r e s s

subject wise uworld

concepts n

spaces n