Gunner Guide to 260+ in USMLE STEP1

Mohammad Alsit Alkhabbaz -

 I recently wrote a post telling my story preparing for step1 and all the struggles that I faced (having major school exams during prep, having to travel, and not being able to sleep at all before exam) and, thankfully, successfully overcame; eventually scoring 264. Here is how I actually did it..


Main Resources: BnB, Sketchy Micro, AMBOSS library (reference), and QBANKs.


QBANKs: AMBOSS (100%), Rx (60%), Medbullets (60%), and Uworld (100%).


Practice Tests:

NBME13: 238 (8 months)

NBME15: 244 (7.5 months)

NBME16: 238 (6.5 months)

NBME19: 252 (6 months)

NBME17: 240 (5 months)


AMBOSS: 257 (3.5 months)


NBME20: 250 (12 weeks)

NBME21: 257 (11 weeks)

NBME22: 257 (10 weeks)

NBME23: 258 (8 weeks)

NBME24: 263 (7 weeks)

NBME18: 264 (5 weeks)


UWSA1: 281 (3 weeks)

NBME27: 262 (2 weeks)

NBME28: 266 (9 days)

NBME29: 267 (7 days)

UWSA2: 269 (5 days)

FREE120: 95% (2 days)

Predictor Sheet: 264


Choosing The Right Resources:

 more is less.. STEP1 requires knowledge across a tremendously large spectrum of content, and the resource options are often overwhelming. There are countless companies trying to get you to subscribe to their platforms, exhausting both your time and budget in the process, potentially making your plan completely out of balance. Thanks to burnout and the forgetting curve, covering extensive resources, like Kaplan, front to back makes the least sense.

 Alternatively, I realized that a resource that had ONLY the high yield content and ALL the high yield content comprehensively explained is all that I needed. BnB was surprisingly just that. In fact, I don’t think USMLE lectures could have been done any better. This resource perfectly checked all the boxes, it’s high-yield but thorough, comprehensive but to the point, technical but enjoyable, making it the best all-in-one video resource for USMLE.


FA:

 First Aid is another popular resource that is also concise and to the point, it has beautiful images and usable mnemonics. The problem is, it’s not comprehensive AT ALL. It was a nightmare trying to burn through the book. I zoned out the majority of the time while using it. This book invites you to rote memorize, and use ineffective study strategies, which is absolutely detrimental. Additionally, the more I used this book, the more I realised that every fact in there is in some shape or form mentioned in BnB. With all of that combined, keeping this book on the shelf made the most sense, as I only referenced it for quick high-yield review and have zero regrets. While useful, IT’S NOT THE BIBLE, and you don’t have to cover it.


Anki:

 Anki is becoming the new Gold-Standard of med students. It claims to nail the fundamentals of learning (active recall and spaced repetition) so well that everybody should be using it.

 Anki is a powerful tool, and the premade decks, like Anking, are very good resources with excellent integration. The problem is with USMLE itself, this exam is concept-based. It is less dependent on raw fact memorization and much more on pattern recognition; I can swear that none of the mistakes I made on my exam was a simple fact mentioned somewhere. I was also consistently scoring in the 260 - 280 range even after I ditched FA and Anki altogether. Knowing a map of concepts rather than individual facts is much more efficient and time-effective.

 Moreover, just like FA, Anki invites you to abuse it, you can easily cross 5 hours a day obsessively doing flashcards and think that you’re doing yourself a favor, while the time used is almost always better spent doing more practice questions and learning more patterns.

 Anki nourishes the compulsive urges of medical students to memorize everything, and successfully allows them to get close, in exchange for thousands of unnecessary hours. Eventually, the goal is to get questions right, which could be done using many leads per a single question, rather than knowing the entirety of the details related to the topic, which I believe is futile.



Notes:

 Taking notes while studying any resource is a waste of time, you’ll end up with piles of poorly written, highly inaccurate, and often ugly content that is always worse than a proper textbook. The familiarity feature of your notes does not excuse that either; for it often makes the situation even worse as you falsely think you have control over the subject. Additionally, you never have time to go through them!

  While notes can be a form of active learning, as you are more engaged with what you're studying, it is the worst choice for doing so. You should still always stop and recap while going through content, making sure that you actually understand and are able to reproduce what you’ve learned, but moving the words of the resource to words on your notes is not the solution.

 Alternatively, I liked to draw my own mnemonics and illustrations, it made me more engaged with the content in a much more creative way, it made going through material highly interactive and more fun. Still, it is not a must, just make sure you are employing active learning to the best degree possible, and do it in a way that you enjoy.


Practice Questions:

 This is the secret weapon to acing USMLE, this single tool is the only “must-do” in this post, as it is the only one placing you at a disadvantage when not using it sufficiently. Quality practice questions are the true application to active recall, and the best way to structure content review. The right time to study a topic is when you’re most curious about it, that is when you are doing a practice case on it. The number of practice questions I did approached 14000, and I don’t regret a single one of them.

 Get a question bank from day one of your prep and don’t spend a single day without doing questions. Build a strategy to approach questions that are confusing and rules that drive your performance in the actual exam. Practice timing so that you don’t spend too much time on questions, at the same time not spending too little and rushing through questions making countless preventable mistakes. I had a long list of what to do and what not to do that I practiced throughout my dedicated period and it made all the difference.

  Do questions on random as early as you can, it’s not only a realistic representation of the exam and prevents “system-wise bias”; it’s also a much better application of spaced repetition, the fundamental of effective learning. Instead of seeing all questions on lysosomal storage diseases in a matter of days, you will see them over weeks or months, effectively reviewing the whole topic every time in a spaced manner which results in better retention for the same set of questions. I noticed a far stronger grasp on STEP1 material in general after a while of doing questions all-random, rather than falsely believing I had mastery over a topic before completely forgetting it after a little while.

  I kept Uworld and most NBMEs for the end of prep; because they are the most similar in difficulty and style to the actual test, and would hence allow me to better construct my strategies and game plan, which I believe was the case. Using other question banks (I did AMBOSS) at the beginning of your preparation is just as good for learning the patterns, save UW to the end.

 Doing any QBANK more than once is suboptimal. Unique questions are a more active and an overall better strategy, and there are as many of them as you may need, covering the same high yield concepts in different wording which is exactly the right formula.


Advice:

  • Take as many breaks as you need
  • Exercise
  • Build your question strategy, don’t just go through the motions
  • Use highly active methods of learning, like making mnemonics and doing questions
  • Do as many questions as possible, preferably on random
  • Your goals are attainable, never lose hope
  • Take regular assessments (e.g. weekly)
  • Use as few resources as possible

This is just an exam, your life is more important, please take care.