Preparing for the USMLE Step 1 [includes a study plan + tips for success]

Today’s [flashback] inane image of the day:

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Step 1 Necessities: Starbucks, First Aid, Laptop, Highlighter
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Taking notes on questions I got wrong in UWorld with different colored pens to enhance memorization.
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Back in my day [haha], I used one of the study rooms on a daily basis and would re-write things I needed to memorize on the whiteboard wall.

This past week I’ve had the pleasure of participating in a number of local AMWA at OUWB activities including a networking event and dinner with an Emergency Medicine doctor. Through these events, I’ve run into M2s that are in the midst of freaking out over the USMLE Step 1 exam. Since most of the entries on wrote with tips on studying for the exam were posted on Kaplan’s MedSchoolInsight, I decided to post an updated version that includes a study plan and tips for success.

Basics 

I took the USMLE Step 1 on May 20, 2013 after one semester of annotating + 5 weeks of dedicated study time. The study plan I settled on was based off of the infamous Student Doctor Network [SDN] Taus Method [click here to check it out and download a copy]. This study plan’s ultimate goal is to read through First Aid three times and complete UWorld prior to taking the exam. I updated the resources in the plan to include Pathoma instead of Goljan [Note: I ended up buying Goljan’s RR Pathology 4th edition as a reference for Step 2].

Study Resources

First Aid

Yes – I purchased the newest edition of First Aid once it was available [in fact, I pre-ordered it sometime in December so that I had it the earliest moment possible]. The concern over errata in the newest edition is a valid one, however, consider it a way to test yourself on your knowledge. If you can pick up on one then you know your material cold [and you can submit it to the FA team to possibly have your name printed somewhere]. I found that by the time I was a couple of months into annotating, errata already started being posted and I was able to confirm my suspicions with the official corrections.

Pathoma

When Pathoma came onto the scene, I was admittedly a die-hard Goljan fan. However, when I finally gave in and started annotating my Pathoma book with the videos, I converted. Which one is best? Hard to say because it really depends on your learning style and how much time you have to cram all of pathology into your < 5lb brain. Personally, if I could do it all over again, I’d integrate readings from RR Pathology into my MS1/MS2 blocks. But because I didn’t do it this way, I stuck with Pathoma.

Microbiology Made Ridiculously Simple

Everyone who hasn’t had any background in Microbiology should read this book. It’s fun, simple and has great illustrations to help you memorize those pesky bugs.

BRS Microbiology Flash Cards

This cards are real flash cards. One characterizing fact with one bug. Simple. Easy to get through the whole deck in a short period of time to reinforce all that memorization you did.

Brenner’s Pharmacology Cards

My study partner ended up transcribing all of the information on this cards into a spreadsheet and we quizzed each other off of that. There’s quite a bit of info on each card, which makes them hard to use as actual flash cards… but I used the info on them through a spreadsheet, so I recommend them. I do remember feeling like I knew every single pharmacology question because I memorized every single drug in this deck.

USMLERx

I recommend getting this QBank MS1 year and using it alongside coursework. If you get the “Till you pass” option [with the AMSA discount, which makes it totally affordable] it will disable your account at 1 year but you can call them and they will reactivate it so that you can use it for 2 years total. This is an indispensable resource for learning First Aid while getting used to answering questions [but by no means are these questions similar in style to the real exam – that’s what UWorld is for].

USMLEWorld

I didn’t purchase my subscription until dedicated study time and I wouldn’t have changed my strategy. These questions are gold and the explanations are platinum, so it’s important to really milk this resource for all that it is. I used a notebook to jot down concepts that I got wrong on UWorld then reviewed them every couple of days.

+/- Picmonic

So I put the +/- because I purchased it toward the end of my study time and didn’t feel like I got much out of it. Had I started using the resource during MS1 year, I feel like I could have gotten more out of it. It’s a cute concept, but there were just too many screens to memorize.

Study Plan

I spent the semester prior to dedicated study time annotating First Aid from the resources I outlined above and the internet [medical students across the country and around the world probably have struggled with similar concepts as you – someone, somewhere has usually posted a great explanation that you’ll just have to dig up through Google]. I did opt to cut the binding off of my book and place it into a binder, though it’s personal preference on whether you decide to do that. [For OUWB students, you can stop by the OU Print Shop on-campus to get this done for cheaper than going to Kinko’s or your local office store]. The advantage to getting it cut is that you can lay the book flat while you’re annotating it.

The order that I studied the topics was based on the order they were taught to us MS1/Ms2 year. Since I was still learning a couple of organ systems alongside my review, I made sure to do the annotations for those organ systems prior to the course completion. For example, I had MSK during the Winter semester, so I studied that material first and annotated the MSK section of First Aid before getting to the basic science stuff that I was supposed to be reviewing per my study plan. I had annotated and read 100% of First Aid once.

Once dedicated study time rolled around, I already hammered out an outline of exactly what needed to be done each day. The goal was to re-read/review First Aid once in 3 weeks and a second time in 2 weeks while also finishing up UWorld. Additionally, as a way to keep up with my progress, I took an NBME almost each week. Keep in mind that the most predictive measure of your score are the practice NBMEs [Note: Step 1 = Comprehensive Basic Science Self-Assessment]. I also did both UWorld Self-Assessments in order to use the questions – these tests are known to inflate your predictive score by 10-20 points, so please do not use them to predict your final score on the exam.

I also planned to take the Practice 150 at the Prometric center that I signed up for Step 1 at. This means that you should not use the “free sample questions” through the USMLE Step 1 website, otherwise you will ruin the utility of those questions when you take it at the testing center. Please note that this practice test is not free [I think I paid $75 or something]. When you complete the practice, you will receive your percentage correct score upon checking out of the testing center.

So, without further ado, here’s my USMLE Step 1 Study Plan – feel free to download the document and use it as a template for your own study plan.

Tips for Success

Here are some final words of wisdom for all of you:

  1. Pick a study plan and stick to it. Don’t let what your colleagues or advisors or anyone else tell you that switching it midway is the best thing for you. If you picked something that ensures you will learn all the material in First Aid and UWorld, you will be successful on the exam.
  2. Take at least one day off each week of dedicated study time. Pick a day of the week that you will always take off – so I took Sundays off because I knew my test day was on a Monday and I scheduled all my practice exams for Monday to simulate the real thing. You will burn out by the end of week 2 if you do not heed this advice.
  3. Take the day before your exam off. All the knowledge you accumulated over the last two years will not magically fall out of your head in that one day that you decide not to study. If you must, make a 1-2 page “high yield” concepts sheet to review the day before, but don’t study seriously, please. You want to be fresh for the day of your exam.
  4. Do not change your test date. Seriously. Unless you had something major happen and you missed more than a week or two of dedicated time because of it.
  5. Make time to exercise or get your heart rate up on a daily basis. Sitting at a desk all day hunched over a book or your laptop is not good for your health. You know that.
  6. Find a study partner. You probably shouldn’t study together all the time because it may end up being counter-productive, but find someone that you can talk to every couple of days or so to complain or ask questions. Also, I found that taking an hour each week prior to dedicated time to quiz each other on pharmacology was the best decision I ever made.
  7. Simulate a full-length exam at least once during dedicated study time. I did this by taking 2 NBME practice exams back to back [this makes 8 sections, not 7… but close enough]. Trust me when I say that the exam itself is not that difficult, but is a test of your endurance.
  8. Pack some healthy food for the day of the exam. Chips and coke probably will lead to post prandial sleepiness. I personally brought coffee to sip on over the course of the 8-hour day, but I don’t suggest doing one thing over another. Personally, I know I’m addicted to caffeine and the steady-stream of it helped keep me alert. Just don’t do something different the day of the exam because it may backfire. And you’ll have a serious adrenaline rush when you sit down to start, so you may not need more stimulants.
  9. You will pass this exam if you prepared/studied adequately. How well you do on it is a function of many, many, many variables, some of which may be out of your control. Regardless, even if you end up doing below what your target was, it isn’t the end of the world. There’s always room for improvement on Step 2.

I hope this helps some of you out there! Good luck to everyone trying to tame this beast of an exam.

What other questions do you have for me?

31 thoughts on “Preparing for the USMLE Step 1 [includes a study plan + tips for success]

  • February 16, 2015 at 11:53 pm
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    GREAT post!! You already know that I love all the advice I can get (those M2s are lucky to have you, stinks not having an upper class!)

    Also glad to hear Goljan RR was helpful for step2, I enjoy him a lot (listening to his Heme/onc lectures on my commute today!)

    When did you read CMMRS? I own an copy and have used it on and off but I think I need to read it through and through (visual learner, huzzah) During dedicated or during the semester prior?

    Id like to know how your friend formatted his spread sheet with the drugs! 🙂

  • February 17, 2015 at 12:00 am
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    Hey Emily!

    For CMMRS I read it prior to dedicated time and didn’t open it once during dedicated. I really did a thorough read from cover to cover and tried to commit all the comics to memory as best as I could. Once I got to dedicated I switched to the flashcards only.

    For pharmacology, Brenner has specific categories that we made the column headers. So drug name was column 1, mechanism of action was column 2, so forth. The primary characteristics I memorized for pharmacology were name, mechanism of action and complications – that took care of a good 90% of everything pharm I needed to know. The rest just comes with exposure to questions and really getting to know First Aid.

    Let me know if you want me to look over your study plan or have any other questions. Always happy to help!

  • April 3, 2015 at 10:40 pm
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    Sorry I have another question about your study plan. For your afternoon sessions you have these numbers in parenthesis, for example: biochemistry (3) p.96-116 … what do the numbers mean?

  • April 5, 2015 at 1:37 am
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    Hey Emily! The numbers in parentheses indicated approximately how many hours I wanted to spend on that particular block. Keep in mind that although I planned out what I would do for each hour of each day, I mostly used it as a guide for what I needed to get done that day. Don’t get caught up in the times and such – it’s more important that you stay focused, so if you get sick of staring at First Aid after 2 hours, then make sure you have a block or two of UWorld questions to do to mix it up. I found that starting the AM with a UWorld block, then switching gears to reading FA for an hour or two then switching back kept me much more focused than trying to stare at FA for 5 hours in the afternoon (especially after lunch – it’s the worst!).

    Let me know what other questions you have!

    Amanda

  • May 9, 2015 at 9:58 pm
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    Hi,

    Your post is really helpful! Thanks for these awesome advice! I just have one question about your study schedule. At the end of each day and also during breakfast, you allotted those times for review. I was wondering how exactly did you review the materials? Did you just skim through what you read for that day or…..?

  • May 10, 2015 at 12:25 am
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    Hey Kristy,

    Thanks for your comment!

    Anything marked “review” indicates time to either 1.) catch up on material or 2.) review the notebook of notes I took on the questions I got wrong for that day/week. I know a lot of my colleagues annotated what they got wrong in UWorld directly into First Aid, which is a great strategy, especially if you have enough time to do your third pass in the last two weeks. However, this doesn’t quite work for studying your weaknesses because you’ll be flipping all around First Aid in order to review what you got wrong on a random block of questions. I personally took notes on all the questions I got wrong in one notebook source (and if it was really important, I wrote it into the margin of First Aid, too) and just reviewed that when I could. Sometimes if I felt antsy about taking Sunday off, I’d flip through this notebook in the AM just to feel like I did something. Either way, look at it as a grab bag time to do some light studying [in the AM to wake your brain up and in the PM to wind down for a restful night’s sleep].

    Hope this helps! Good luck on your exam and feel free to ask any additional questions!

    Amanda

  • May 21, 2015 at 11:06 pm
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    Hey Amanda,
    I love this schedule! I’m about to enter first year and my school doesn’t have the best Step 1 average so I’m trying to see what I can do to set myself up best. I know some people advise annotating their block material into First Aid, What would you advise doing throughout years 1 and 2 in terms of review sources? Also, I originally stumbled upon your blog because my boyfriend of 3 years will also be going to medical school across the country (the impending distance is already getting to me!) and I was wondering, did you stay with Mike during your weeks of dedicated study? Or did you go home or stay at school?

    Thanks for all of your great advice on your blog! Giving me lots of hope in all the ways 🙂
    D

  • May 22, 2015 at 4:22 am
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    Hi D,

    First off, CONGRATULATIONS ON YOUR MEDICAL SCHOOL ACCEPTANCE!!! Your next 4 years will fly by – relish in it!

    Second, so for M1/M2 years, the most important thing is to figure out how you study best. Most of us found out that doing questions from a question bank makes a huge difference, so picking up something like USMLERx for M1/M2 years is great (it’s $199 for “until you pass” which is 2 years access – after 1 year, you have to call them to renew it for you, but they give it to you no problem… unless they changed the terms). Also, buy First Aid early on so you can become familiar with the format and locations for specific things – remember, you shouldn’t use First Aid to learn the material, but just as a good place to review material. There are numerous organ system specific books that I’ve listed somewhere in my blog… I’ll have to dig them up and make it easier to read. But I definitely remember get Lilly’s Pathophysiology of Disease for Cardiovascular – it is AWESOME. I referenced it when I was on my 3rd year clerkship, too. =)

    We had NBME exams, so using First Aid for Organ Systems with a question bank was usually enough to honor the exam. If you do not have NBMEs, obviously you’ll have to study your lecture material *and* try to make sure you understand the First Aid testable material.

    So, having Mike around would have 100% been a distraction for Step 1 studying. We planned a post-Step 1 trip to Maui, so I knew that after 5 weeks of grueling studying that I had a sweet treat to look forward to. Especially after you get into the groove of a long distance relationship, you’ll find that those limited moments with your boyfriend are especially important to be present – not studying, not freaking out about an exam and not thinking about medical school. Because the two of you are in medical school, you might want to talk about it while you’re together, but try to keep your precious time sacred when you can. Do fun date-like things (whatever your style is) and make a point to plan your (or his) next visit so you *always* have something to look forward to!

    Let me know if you have any additional questions!
    Amanda

  • August 26, 2015 at 9:52 am
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    Hi Amanda,

    Thank you for putting in time to write this post. I feel like I need some type of guidance to get through all this. And your post is very helpful.

    Before I jump into dedicating study time for Step 1, I want to throughly review all the basic sciences. Can you suggest any helpful material?

    And did you ever use the Kaplan books while you were studying for Step 1?

  • August 26, 2015 at 3:46 pm
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    I’m an international medical student. To be honest, I didn’t take my first two years seriously. And I want to build my basic science foundation before I start prepping for step 1. Now I’m in my last year in medical school and I’m so serious to put my heart and soul into preparing. I don’t have much guidance and I’m so confused on what to do. Is there any advice you can give me.

  • September 12, 2015 at 7:59 pm
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    Hi there! I’m going to respond to both of your comments here.

    All the advice I can give you is already in my post – you have to make a realistic plan and stick to it, otherwise you will never learn the material. Figure out what learning style works best for you and use it during your study time. Do not be discouraged by setbacks – just vent your frustration in a healthy way and realize that a new day means a new opportunity to learn the material and improve.

    Since I’m so far removed from the basic sciences, I don’t think my recommendations would be helpful. Personally if I had to review the basic science material again, I would focus on the basic science section of First Aid and use the internet to clarify the concepts along with doing questions to guide my studying.

    For Step 1, I did not use any Kaplan books. Since there is a limited amount of time, it is important to focus your attention on the materials that will give you the greatest yield. If you have more time, it makes sense to look into other materials such as Kaplan.

    Good luck!

  • September 15, 2015 at 7:12 pm
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    Hi Amanda, Thank you for the post. you said you used a spreadsheet for pharmacology and on your schedule i noticed you did pharm everyday, is it possible fr you to send me the spreadsheets

  • September 29, 2015 at 1:07 am
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    Hey Amanda I was wondering if good answer a quick question for me. His research really that important when applying for residency? With everything that I’m throwen at in school I find it hard to find time for anything like research

  • November 8, 2015 at 1:58 pm
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    The importance of research hinges on what specialty and type of program you are interested in. Certain competitive specialties won’t even consider candidates that haven’t had substantial research experience while other specialties do not place as much emphasis on it. Residencies in large academic medical centers tend to also weigh research experience more heavily. Even if you’re not the PI on a project, you can still seek out opportunities to participate in the research process – most programs don’t expect you to be doing cutting edge research while a medical student, but want to see that you’re curious.

    Hope this helps!
    Amanda

  • November 8, 2015 at 2:06 pm
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    Since the spreadsheet was pretty much verbatim what was on the pharmacology flashcards I purchased, I do not feel comfortable sharing a copyrighted item. My apologies! Keep in mind that there are tons of already pre-made study sheets out there on the internet – just search for them. Also, just making one yourself is a way to study the material. =)

    Amanda

  • January 20, 2016 at 7:55 pm
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    Hey Amanda
    As for an IMG who graduated from med school 3 years back, and is preparing for step one, I bought first aid and pathoma and im planing on having usmle rx as my first qbank and uworld of coarse, what would you recommed in terms of how much time I need, and books to review, knowing that I work 8 hours a day.

  • February 6, 2016 at 12:22 pm
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    Hey Maher! Thanks for commenting. I would really ask yourself how much time you’ll be able to dedicate to studying and go from there. Having graduated a few years prior means that you’re at a disadvantage – the material is no longer fresh in your mind and it may take sometime to get back into the swing of things. Also – if you’re not in a clinical setting at all, it will take a significant amount of time to catch up again. Remember that most medical students get at least a month of dedicated time to studying – I probably studied at least 8 hours a day for 6 days a week (so let’s say ~50 hours a week x 5 weeks = 250 hours total). I’d give yourself at least 4 weeks of time (so let’s say ~200 hours) and then let your performance on UWorld guide whether or not you’re ready for the exam. Take NBMEs in order to gauge your progress, too.

    Good luck!
    Amanda

  • February 13, 2016 at 11:14 am
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    hey-

    I’m a DO student and I’m interested in gas too. I know I’m a little late to this, but I’m glad I stumbled on your blog. Do you mind if I ask what your score was? If you can see my email, you email me back on that if you prefer. Thanks!

  • February 13, 2016 at 2:00 pm
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    Hey Alex,

    Thanks for your comment! My score was slightly above average. This being said, many of my peers that followed the same schedule did 1-2 standard deviations above the mean. No study plan is foolproof – at the end of the day, it all depends on how well you’re actually retaining the material and how you do under stress on test day.

    Good luck!
    Amanda

  • April 16, 2016 at 10:38 am
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    Hi Amanda,
    I’m a second year DO student gearing up for COMLEX/USMLE. One question about the study schedule: how exactly did you go about incorporating Pathoma into it? It looks like you blocked out time for it during lunch according to the color coding, but did you just study by chapter or pick and choose based on what was on the schedule in the afternoon? Thanks so much for posting this. I feel a lot better about how I’m going to attack these exams!

    Rich

  • June 11, 2016 at 9:31 am
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    Hey Rich,

    You’re probably either in the midst of studying or finished with Step 1 by now – my apologies that intern year got the best of me! Just for historical purposes, I tried to integrate Pathoma material that related to the section I was studying as best as possible – so if I was going over Neuro, I’d try to go through the CNS Pathology section.

    Good luck to you!
    Amanda

  • July 22, 2016 at 8:45 pm
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    Hi Amanda.I’m an IMG and my school was all over the place in terms of teaching properly. I also have myself to blame because I didn’t push myself hard enough to study on my own time. Now I feel like I have only a year left to start properly studying for Step 1. Do you think its possible to get a good mark on Step 1 only using Pathoma, 1 year of UWORLD, and First Aid for the next couple of months? Or should I use more comprehensive books and review materials?
    Thank you

  • July 25, 2016 at 5:23 am
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    Hey!

    I do believe it’s possible to do well with just those 3 resources AND using the internet to supplement any deficiencies in your knowledge. Most review books and materials cover the same information but are packaged a little differently – picking a resource that you’re able to stick to is the most important decision you can make. You should also make a plan for studying since a year is a very long time and it’s easy to burn out when all you are doing every day is studying for this one exam.

    Let me know if you have any additional questions and good luck!
    Amanda

  • April 13, 2017 at 10:36 pm
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    Hi Amanda,

    Thank you so much for your post. It’s amazing!! I am a fellow OUWB student and I am taking my Step I end of May. I was wondering for Uworld, did you mean that you took 2 blocks and reviewed them in 4 hours total? I feel for me this would be insufficient since I review kind of slowly and I want to do 2 blocks a day but I feel it’s going to take me longer to do. Any recommendation on this matter?

    Thanks!

  • May 11, 2017 at 10:22 pm
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    Hi Amanda,

    In regards to your schedule, were you able to review 1 block f Uworld in 1 hour? I am having a little trouble reviewing a block in an hour and was wondering how you went through when reviewing. In addition, what did “daily review” and “week material review” consist of? did you just go through your Uworld Journal? Or did you flip through First Aid? I think my main concern is wasting time passively reading first aid. I guess I could also ask, how did you read actively read through first aid during your afternoon sessions?

    Thanks!

  • July 13, 2017 at 9:16 am
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    Hi, I’m an IMG and aiming for a score of 250+. I have been preparing for this for the last 8 months and reached a point where I’m scoring an average of 210 in NMBE. Have been doing youworld as well and scoring 70% in it.
    Difficulty is I’m confusing between two similar options and getting it wrong. I really want to improve it to 250 and have my exam in a month. Please suggest. Appreciate any kind of help.

  • August 3, 2017 at 9:34 am
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    Hi so I’m studying for Step 1 as an IMG post 3rd year: I still have 2.5 months but the truble is about 2 of those are while im on placement (don’t ask our school is super wack); any advice as to how to balance my actual schoolwork and studying for step 1?

  • August 7, 2017 at 12:00 pm
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    Thank you for your comment! The struggle is always trying to balance life/school with Step 1 studying and many have struggled to find an answer. What works best for one person doesn’t always work for the next. Personally, I need some sort of plan in place to stick to in order to get tasks done – whether that’s a to do list or specific goals that need to be met. Break up your studying for the next 2.5 months into smaller chunks that are manageable (and realistic – that’s the most important thing!) and recognize that you’ll have to reassess every couple of weeks to ensure that you’ll meet your goal. Make a study plan and get loved ones or your support network to cheer you on to ensure you stick to it as best as possible. Sometimes having a study partner can be helpful to keep you accountable.

    Hope this helps and good luck!

  • August 7, 2017 at 12:06 pm
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    Hi Sudha!

    Thanks for stopping by and my apologies for the serious delay. This response is mostly for historic purposes in case others have similar questions.

    The NBME is truly the most representative test you could do to predict your performance on the real exam (other extenuating factors aside). Have you really taken a hard look at the areas where you feel deficient? If you feel like it isn’t a knowledge problem but a test-taking one, then look into strategies to improve upon this. For example, it can be very helpful in long questions to read the actual question and answer choices first before reading the stem. Then eliminate the options that you recognize are wrong until you get down to either one or two options. As you mention, getting stuck on two similar options is a pretty frequent challenge – but if you understand the question and the concepts, you have to work on your reasoning in order to find the *most* correct answer. Sometimes being stuck between two similar choices is a reflection of a deficiency in knowledge.

    Hope this helps! You may want to consider finding an advisor to help focus your test-taking skills and strategy.

    Good luck!
    Amanda

  • August 7, 2017 at 12:56 pm
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    Hi There!

    Thanks for stopping by and my sincerest apologies that I didn’t reply in a timely manner! I’m replying just in case someone is in a similar situation.

    I agree that passive review of First Aid is pretty useless; generally my reviewing of FA was making sure I could recite specific areas of a page or looking up some sort of background information to help me truly grasp whatever concept I was reading. Most of the time, you will know where your weaknesses are; so I used my FA review time as a chance to find those holes again and really attack them.

    Keep in mind that what I did may not be helpful for you. Perhaps you’d be better served reviewing your notes from questions or watching Pathoma. I hope that those of you using my schedule just see it as a guide for creating your own study plan!

    Good luck!
    Amanda

  • August 7, 2017 at 12:59 pm
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    Hi There!

    I am so sorry I didn’t get a chance to reply to you earlier! Seeing that you’ve already taken Step 1, I’m replying to this in case someone has a similar question.

    My study plan was merely a guide for me – some days I needed to spend more time reviewing and other days, I needed less. Blocking off specific times was a way to help me structure my studying for the day but honestly I didn’t stick to it super closely. Eventually, I ended up seeing it as a checklist for the day/week to ensure that I was making some progress in my studying. I adjusted the schedule when I got behind and revamped it as I became more burned out from studying at the end of the dedicated time.

    I hope that all went well for you and clerkships are treating you well! Say hi to the OUWB crew for me and let me know if you’re ever in the Boston area.

    Amanda

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