Received my score on 1/21/2009.
Microbiology: Kaplan notes & Kaplan webprep,
Initial goal: 250+
Total prep time: 1000 hours.
IMG at an Australian medical school (UQ);
MCAT=38
NBME 1: 258 (9 months out)
NBME 2: 261 (2 months out)
NBME 6: 262 (25 days out)
UW 1: 265+ (15 days out)
NBME 3: 265+ (8 days out)
NBME 4: 265+ (6 days out)
UW 2: 265+ (4 days out)
NBME 5: 265+ (2 days out)
USMLE CD: 96% (1 day out)
I did over 10000 USMLE-style practice exam
questions in the following order:
USMLERx: 94%
Kaplan Qbank: 91%
First Aid Q&A step 1: 93%
UW: 88% (Random, unused, first time through)
Plus NBME + UW exams + USMLE CD + RR
Goljan...
Prep material:
FA of course!! I read it cover-to-cover 3 times.
However, I tend to cross-reference it when I
read other books and I frequently consulted it
during second year during PBL. I also
annotated notes in FA when I did UW, so I was
very familar with the content of this book. For
every diagram/table/metabolic pathway in FA, I
made sure that they were familiar to the point
that I was able to to reproduce them from
memory.
Anatomy: Kaplan notes & Kaplan webprep,
USMLE Road Map Anatomy, HY
Neuroanatomy.
Behavioural science: Kaplan notes & Kaplan
webprep.
Biochemistry: Kaplan notes & Kaplan webprep.
Cell biology: HY Cell and molecular biology.
Micro Made Ridiculously Simple, MicroCards.
Immunology: Kaplan notes & FA.
Pharmacology: Kaplan notes & Kaplan
webprep, HY Pharm, Pharmacology Flash
Cards (Brenner).
Physiology: Kaplan notes, BRS Physiology.
Pathology: BRS Pathology, Goljan audio,
Goljan notes.
Preparation timeline:
Probably quite atypical compared to most US
medical students. I initially intended to sit the
exam at the beginning of third year, so I spent a
month studying after second year was over. At
the end of the month, I didn't feel quite ready
and decided to postpone my exam till the end of
third year, thinking that I would have plenty of
time to study during the clinical
rotations. Wrong. I only had some time during
my rural rotation and psychiatry rotation to
study for USMLE, but could only manage to do
1-2hr/day on weekdays and up to 8hr/day on
weekends. At the end of third year, I spent a
month studying hardcore again, and finally took
the exam on the 26th of December. The
Australian school year runs from January to
November, by the way.
During second year - Read BRS Pathology and
pretty much memorized the book. I love
pathology so it wasn't really a daunting task for
me. I also started listening to Goljan audios in
first year and I was really glad that I started
early. I finished Goljan audios at least three
times, but I always felt that I learned something
new each time.
December 2007 - Finished reading Kaplan
notes (all subjects except Path) and Goljan
notes for Path. 8-10hr/day. (300hr)
Jan - Nov 2008 - On and off. I did NBME1 in
March and got 258(720) and was pretty happy
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that reading Kaplan notes paid off. However, I
had only about 4 months during this time (rural
and psych) where I could fit USMLE studying
into my schedule, but could only manage to
study about 25 hours a week. During this time, I
read the supplementary material (HY, Road
Map, flash cards), listened to Kaplan webprep
while commuting, and did the majority of the
practice questions. (400hr)
December 2008 - Did most of the NBMEs and
UW assessment exams in this month.
Completed UW question bank for the second
time. Spent the last week just memorizing FA
and doing practice questions. 8-10hr/day.
(300hr)
Exam on 2008/12/26:
I started the exam at 8:30 and finished at 4:00
with 20 minutes of break time to spare. On
average, I spent 45 minutes in each block and
took a 20-minute break after each block (except
the first block). During each break, I would drink
300mL of oolong tea or green tea to keep me
awake, eat half a sandwich, go to the
washroom, and wash my face so I felt refreshed
and ready to tackle the next block. I thought the
strategy worked quite well for me.
I thought the exam was quite a bit harder than
NBME but easier than UW. It was probably
comparable to UW self-assessment exams in
terms of difficulty. I marked 6-7 questions each
block. I thought 85% of the questions was
straight-forward, 10% was tricky, and 5% was
difficult.
Pathology: Not surprisingly the bulk of the
exam. Around 70% of the questions were
patholgy questions or required pathology
integration. I thought UW covered these sorts of
questions really well, so there weren't really any
surprises for me. I only had around 5 questions
that came with pictures of gross pathology
specimens.
Anatomy/neuroanatomy: 15 questions. Most of
them involved intepretation of X-rays/CT/MRIs,
nothing too obscure. I even had brain CT and
angiograms for structure identification. Make
sure you know the brain stem and cranial
nerves well.
Behavioral science: 20 questions. Half were
biostatistics, and the other half were the typical
"what would be the best action/response in this
scenario" type of questions. I thought just
reading FA or Kaplan notes was not really
sufficient to answer these sorts of questions. I
had almost no questions that came out of the
psychiatry section in FA, except a few
psychotropic medications and a question on
defense mechanisms.
Biochemistry/Cell bio/Molecular bio: Geez, I
noticed the trend of increasing proportions of
cell biology questions in the NBME, but I never
expected this many on my exam. I probably had
50 questions that fell into this category
(Biochem/Cell bio). I was glad that I flipped
through HY Cell and Molecular biology just a
few days before the exam, because it probably
helped me answer 5 questions correctly. The
different kinds of receptors and intracellular
signalling pathways are extremely high-yield.
For metabolism, know the key regulatory
enzymes and global control of metabolic
processes (i.e. insulin vs glucagon's effects).
Pharmacology: Around 25 questions. Piece of
cake compared to UW. I thought FA covers
pharmacology in sufficient details. As usual,
emphasis was placed on autonomic
pharmacology and cardiovascular medications.
I had quite a few questions on
pharmacodynamics too.
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Microbiology: 30 questions. Make sure you
know the various bacterial exotoxins and their
mechanisms of action. Quite a few questions
involved TB and HIV. Even West Nile virus
appeared on my exam.
Physiology: 30 questions. Most involved the
up/down arrows and graph interpretation.
Endocrine questions are high-yield too.
I walked out of the testing centre feeling quite
confident I did pretty well. I was certain I broke
260, but wasn't too sure if I was able to get
270+. Got the score last Wedneday, 276/99! I
didn't even know it was possible! Needless to
say, I was ecstatic!!
============================
I've compiled a Q&A from the emails and PMs
I've received since last Wednesday. I'd like to
thank those who emailed or PMed me and also
their permission to post their questions up. I
hope this answers more questions regarding
my exam preparation.
Learning Resources:
Q: What edition of Kaplan notes did you
use, and did you use the accompanying
videos?
A: I used Kaplan notes 2004 edition. I was
running out of time toward the end of my
preparation so I didn't use the videos.
Q: Did the Kaplan webprep audios make a
big difference where the lecture notes are
concerned?
A: I wouldn't say the webprep audios were
essential, but they certainly helped solidify
many important concepts, especially for
biochem and pharm. If time is a factor for your
preparation, I would suggest doing the webprep
audios only after you finish reading the lecture
notes.
Q: First Aid how much does it cover?
A: FA covered about 80% of the material on my
exam, so I would definitely recommend using it
as the primary resource the week before the
exam. I went over the rapid review section at
the end of FA the night before the exam date,
and I found it quite helpful as a last-minute
review.
Q: Do you think the lecture notes for
biochem are okay to use without the
videos?
A: I think the lecture notes for biochem are
adequate to be used on its own; I didn't use
Kaplan videos so couldn't comment on them.
However, I would highly recommend listening to
webprep for biochem. Dr. Raymon is just simply
amazing; he does an excellent job integrating
pathology, pharm, and biochem. However, it is
still of utmost importance to memorize all the
tables/diagrams/metabolic pathways in the
biochem section of FA. I think it really ties the
information together nicely toward the end of
the preparation.
Q: For Pharmacology, do you think studying
FA is enough?
A: I think FA is enough for Pharm, provided that
you know the mechanisms of the drugs well. I
found it quite difficult to memorize the list of
clinical uses and side effects without having a
solid understanding of the mechanisms, so I
chose to do Kaplan notes before tackling FA,
and it certainly made those things easier to
memorize.
Q: Did you like the Pharmacology flash
cards you used or were they too detailed?
A: I liked the flash cards, they are handy to
carry around if you want to study them on the
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bus or during a boring lecture. It can also be
conveniently used to quiz yourself, with the
drug's generic name and trade name on one
side, and the list of drug class, mechanism,
clinical uses, side effects, route of metabolism
on the other side. I don't think they are overly
detailed.
Q: Despite reading Microbiology Made
Ridiculously Simple over again, I am still
missing tons of micro questions. I dont feel
like there is anyway to "master" these
questions cause they often test trivia that
while I know I read, I just cant recall on the
spot. Although, I do think my main problem
here is focusing too much on MRS and not
on FA.
A: I agree with you that using FA to supplement
MRS would be very helpful. It's a good idea to
start with MRS in the beginning of your
preparation, but toward the end, the tables in
MRS and the charts in FA are the way to go. A
heavy amount of rote memorization is required
to master Microbiology, that's for sure. I would
encourage you to focus on the classifications
and lab algorithms first before you start
memorizing the rest of the minutiae.
(Remember: Big pictures first!) The gram
positive and negative lab algorithms in FA are
gold. Pay close attention to the bacterial
exotoxins as well, because they frequently
appear on the exam. Make sure you know
these like the back of your hand. For virology,
use the mnemoics in Kaplan notes to remember
the DNA, +RNA, and -RNA viruses.
Q: You mentioned that kaplan and FA were
not enough for behavioural and biostat
questions. Any suggestion what shall I go
for to cover that?
A: A lot of my friends liked HY behavioural and
biostats a lot, but I have only read the first few
chapters of HY ** so I can't really comment on
them. I didn't like Kaplan and FA because they
focused too much on the psychiatric disorders,
and not so much on the "best response/action"
scenario type of questions. The practice
questions from UW and NBME are very good
though, and I would recommend doing as many
questions like those as you can, so you're
familiar with the concepts. Sorry to confuse you,
but for biostats, I think FA is quite sufficient, but
make sure you are comfortable doing those
calculations and drawing those 2x2 tables.
Doing lots of biostats questions will definitely
help solidify the concepts.
Q: How much do you get through a day and
how do you retain that information? One of my
problems is that I get through maybe 30 pages
of Kaplan Biochem notes a day, and at the end
of the day, while I retain the information, I find
that I really didnt learn that much. Furthermore
more, I tend to forget things as I go. When I do
questions later on on the same subject, I forgot
much of what I learned maybe 2 weeks ago.
A: Don't worry too much about having to retain
everything in Kaplan notes, it's impossible and
often unnecessary to try to remember some of
the details. I think the primary purpose of
reading Kaplan notes is to help you understand
FA later on so you can memorize the facts in
FA with better ease. What types of questions
are you getting wrong, are they questions that
require straight fact-recall or ones that require
you to apply a concept? If it's the former, I
wouldn't worry too much about Kaplan notes
and would probably spend more time studying
FA instead; for the latter, you do have to make
sure you comprehend the info in Kaplan notes
before moving on to FA.
Another thing I found helpful was to read the
corresponding section in FA after finishing a
subject in Kaplan notes. It helps solidify
information right away.
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Q: How many pages of FA and kaplan notes
can you get through in a day?
A: I set goals to get through 100 to 120 pages
of Kaplan notes every day, at the speed of 12-
15 pages per hour. It depends on the subject
too; anatomy and biochem were slower,
whereas physiology and pharm were faster
because I had done BRS physiology and
Pharmacology flash cards already. I could read
around 60 - 80 pages of FA in a day toward the
end of the preparation, but when I first started, it
was painfully slow. I could remember spending
an entire day just studying the embryology
section, which was only a few pages long but
very memory-intensive. But once you start
remembering the mnemonics and are familiar
with the content, the speed goes up quite
quickly.
Question banks:
Q: Did you do questions after each subject
during your initial read, or did you skip
questions altogether until after you
completed your first read?
A: Thanks for raising this point as I probably
didn't make it very clear in my post. I started
doing questions after reading all of Kaplan
notes, BRS path and phys, Goljan notes, and
most HY books that I mentioned. The only book
that I was still reading after I started doing
questions was FA.
Q: When you say you did 10000 questions,
do you include the book questions or any
other questions?
A: I only counted the questions in USMLE
format.
UW (2000) + Kaplan practice tests (2000) +
Kaplan Q-bank (2000) + FA Q&A (1000) +
USMLERx (did ~2000) + NBME 1-6 (1200) +
UW self-assessment 1&2 (400) + Goljan RR
Path questions (100) = 10700
I didn't count BRS questions or questions in
Kaplan notes because they were not always in
board format.
Q: Did you do robbins review of path? Was
USMLERX useful?
A: I didn't do Robbins, and I wouldn't
recommend it either. USMLERx was okay in
terms of helping me memorize some details
that I wouldn't have paid attention to in FA,
because this Q-bank is basically based on the
material in FA.
Q: Would you say that a particular question
bank or all the 3 question banks that you did
do cover all the usmle questions (=subject
matter) that you were asked?
A: I would say UW was the most high-yield of
them all. USMLERx and Kaplan Q-bank have
been known to test minutiae that are not
necessarily high-yield info. These 3 question
banks combined definitely covered more than
any one of them alone. As I mentioned in my
post, only 5% of questions on my exam were
things I had never encountered before, so doing
tons of questions was certainly helpful for me.
Q: I am dedicating a solid 8 hours everyday
to question banks (I time myself), but my
scores are not improving. What can I do?
A: I would recommend going over the
explanations in more detail, making sure you
really understand what the question is asking.
Don't skip the explanation for questions you
answered correctly; you can learn a lot by
reading about why the other choices are wrong.
It can take a very long time when you first start
doing it this way, but after a while, if you learn
from your mistakes, you will not get the same
type of question wrong again. When I first
started doing questions, it often took me 40
minutes to do 50 questions, but an hour to read
the explanations and annotate notes into FA.
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However, I learned a lot from the explanations
in UW, probably just as much as the questions
themselves. It's easy to feel frustrated when
you first start, but with time, I'm sure your
accuracy rate will improve. Good luck.
Q: I am quite frustrated with questions that
test minutia details, e.g. "Which of the
following can be found in bacterial
endospores?" (Answer is dipicolinic acid) I
had never seen anything like that and I had
to flip through pubmed to get the answer.
Are these questions worth remembering?
A: I'm not trying to discourage you here;
although dipicolinic acid is probably a trivia type
question, it was actually mentioned twice in FA,
so I'd actually still remember it. Sometimes the
strategy is to eliminate the other answer
choices if you couldn't recognize the right
answer. For example, if other choices are
peptidoglycan and mycolic acid, you know they
just can't be right.
Q: What did you annotate into first aid? Only
qbank questions? I find some of the Micro
Qbank questions extremely tedious and
testing pHD like material. How can I tell if its
important? Or is it all completely important?
A: I only annotate information that I consider
"high-yield". As you do more questions, you'll
soon know what types of questions tend to
show up over and over again; these are the
ones that are high-yield.
Take Micro for example, they often give you a
clinical presentation of an infectious disease,
then ask you for the most appropriate
antibiotics. These require a two-step process
(Presentation - Bug - Antibiotics), and are
guaranteed to be on exam. If they want to be
mean, they can ask you about the side effect of
the most common antibiotics used. These
questions require a three-step process
(Presentation - Bug - Antibiotics - Side effects),
and are less common than the type of
questions above. Things that aid in the
laboratory diagnosis or things that have to do
with treatment (for example, HIV gene products
and antiviral drugs that target these products)
are also extremely high-yield. Ignore the weird
trivia type of questions that have no clinical
correlation.
I agree that Micro Qbank questions can
sometimes be a bit annoying, but that doesn't
mean the real exam is like that. I found that FA
covers > 90% of the Micro questions on my
exam, so make sure you know FA well and
don't get too discouraged by the low-yield
questions.
Q: About doing usmleworld 2X: did you find
that helpful even though you already did the
same questions once?
A: I did UW again one month apart. I don't think
there's much benefit doing it again right after
you finish it first time through, but a month gives
you enough time to test if you really understand
the materials tested, and not because you
memorized the questions and answers. For me,
the second time helped me increase my speed
as I was more comfortable dealing with long
question stems (but that could be an effect of
having seen the questions before as well).
Q: When should I do UW again?
A: I would recommend doing UW again as
close to the exam date as possible, while still
giving yourself enough time to go over FA again
and do the rest of the NBME forms. I went
through UW the second time 3 weeks before
my exam; I did 350 questions every day to
simulate the exam length and build up my
stamina. When I finished, I still had 2 weeks left
to review the material that I mentioned above.
Q: When did you really start feeling
comfortable with the material?
A: I probably started feeling comfortable with
the material after I finished Kaplan notes and
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had done 2000+ questions. By that time, I knew
my strengths and weaknesses and knew what
to focus on in order to get the most out of the
review process. For example, after doing some
questions, I realized I had a lot of trouble with
neuroanatomy, and so did HY neuroanatomy
for 2 weeks, which seemed to effectively
remedy the problem. Besides, as you do more
questions, you soon realize the amount of
information that FA actually covers. The
questions also help you remember the material
in FA more easily.

Q: Any advice on test-taking strategies?

A: One thing I found really useful from doing
tons of questions is that on the real exam, I
could often read the question stem and predict
what type of question they were going to throw
at me. I would also recommend coming up with
your own answer in your head before you look
at the answer choices; reading the other
answer choices (distractors) before committing
to a response can be confusing, especially
when you're not very certain of your answer to
start with. Of course, if you really have no idea
what the question is getting at, reading the
options first while using the process of
elimination is often helpful.

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