 This will be a long one to read for you.

It will be filled with “My Own Perceptions

Regarding Step 1”.
 I will be completely honest with you during this. So, Judge me all you want. 
 I am going to talk about things most experiences don’t cover. If you are just here to
see my scores and compare with yours, don’t bother reading this long one.
 By writing this experience, I am NOT targeting students who are in top 10% of their
class. I am writing this for people like me, who were at my stage (knowledge level),
i.e. performing in bottom 10% of class during their Undergraduate (UG).
 If you wanted me to give you a magic pill, let me be clear, very clear man. There is
no elevator to success here, you have to take the stairs. All I can do is I can
guide you which stair goes to the top & which ends abruptly in the middle!
 I will be sharing the correct method to read/approach the same source used by
everyone. (Everybody uses the same UWFAP, but not everyone scores nearby.
Scores depend on how you use that same resource.)
 This should be your AIM if you are going to read it all. “How to approach any
subject/system in a proper way that would save your time and make you more
efficient”.
 I had basics weak so I had my own different way to study.
 I will give you the action steps to get at least 240+ in minimal time. (Don’t get
mislead by my words, if you don’t have basics clear then you will need to work your
ass off and clear those before you start seeing 230s & 240s in NBMEs.
 If you don’t have time, just read UW (Tips & Tricks for UW) & First Aid (How to use it
for 1st, 2nd, 3rd, 4th time readers?). If you will read this till the end, I am sure your
perspective for Step 1 will be changed! You would not feel this experience a waste of
time at all.
 I am writing major portion of this before I get my result so I can be totally unbiased! 

I was a bottom 10% of my class during my UG. Barely passed 2nd MBBS with Grace Marks
(which is the major portion of Step 1). I am not bragging about myself here. I am writing this
because I know not everyone preparing for step 1 is from the top 10% of the class. Not
everyone struggling with basics had read awesome author books during undergraduate. I
am writing this so that you guys can relate to it and can get an insight that everything is
possible with the right guidance and dedication.
This was me back in 2017. Didn't know the difference between
Bacteria/Virus/Fungus/Parasites (not kidding, they were all just the same bugs for me),
DNA/RNA Replication was Nightmare, Macrophage/Neutrophil/Granulocytes were all the
same for me. Simple mechanisms of CVS/RS/Endocrine were demanding. Had a hard time
understanding Biochemistry correlations. Neuroanatomy felt like climbing the Mount Everest.
Pharmacology, ah. Adrenergic and cholinergic were just 2 rhyming words for me.
Mechanisms of Antimicrobials and antineoplastic were totally unknown to me till now.

Getting a passing score at that time was a big deal for me. 220 was just a dream for me at
that time. (Self-talk)
My story was different. I was sincere medicine aspirant till I passed 12th. After getting
admission in MBBS, I now had the “Red-bull Wings”. All I would say is I enjoyed those 2.5
years at fullest. After barely passing 2nd MBBS without basics clear, I found myself helpless
in many medical/social situations. Those embarrassing incidents and guilt of being helpless
made me ask a question to myself, “Who am I?” & “What was my motive to enter this field?”
I soon realised that I need to gain knowledge and be educated as well as experienced for my
dream to become reality. I now need to climb the steepest mountain to become successful in
life. (This change from spending 15 hours a day chilling & relaxing to 15 hours a day in
library chair wasn’t the easy one. You too might have experienced this.)

Who am I today is just because I have overcame plenty of hurdles to make a major change.
Just correlate this with you, you might have been in the same position struggling/finding a
chance that will change your life. It’s not too late to get a fresh start and start doing all you
want in life. You will get rough time during this journey, you will have to face unforeseen
hardship & emotional pain. But once you will get through this, your life will be different. You
will learn many things during this journey!

I made a firm commitment to clear every basic concept and reach the peak level
performance. And most importantly to get satisfied with my knowledge level. Thus, I didn’t
make any specific 230-240 Goal. Because I felt by doing that, I was limiting myself to a
certain point, which I don’t know is/isn’t my best. (“Peak” as said by USMLE Seniors!)

August, 2017 to May, 2019 (22 Months)

January, 2019 to May, 2019 (5 Months)

As I have already explained, I wanted to clear every single thing. People suggested me to do
Kaplan. Which took me 8 months to finish!! Also I was procrastinating at reading because
there was so much to do in front of me at once. Journey of getting my shit together wasn’t an
easy one. It took me months to reach 12-13 hours from 2-3 hours a day of study time.

There are so many resources for step 1 available for us. You just can’t finish them all. There
might be many experiences which tells you what TO DO, but if you know what NOT TO DO,
might save your precious time.

If I would knew the details I am going to share with you now, I would have finished
this journey earlier with more points in my bucket.

Let’s get into it…

Kaplan Lecture Notes & Videos:

Pros: Gives enough base upon which you can build a strong core. Gives general ideas and
helps you to adapt a thinking pattern regarding boards. It really helps only if you have no
idea regarding the whole subject.
Cons: Time Consuming, Lengthy, You won’t be able to revise, You will forget most things by
the time you enter dedicated period.
My Advice: Do it if you are an old graduate or you are very weak at basics. If you are recent
graduate with at least some basics clear, then you would feel this waste of time. But at least
do Kaplan for below mentioned subjects even if you consider yourself a pro.

1. Biochemistry (Dr.Sam Turco) (MUST DO)

2. Neuroanatomy & CNS (Dr. White). (MUST DO)
3. Behavioural Science (Dr. Steven) (MUST DO)
4. Physiology (Do it if time is not an issue)
5. Pharmacology (Do it if time is not an issue)

Other subjects can be skipped if you don’t have time.

Sketchy:
Pros: This will make Micro a piece of cake for you by the end. A must resource for
Microbiology. Period.
Cons: It will be a lengthy, tiring process of remembering all the bugs as a picture form during
first go. You will need to revise it 3-4 times before you become a pro at it.
My Advice: Do it anyway, no matter how difficult you find it during first time. Just do it, you
will thank me later for this.
You don’t actually need to do Sketchy for Pharmac or Patho. Doing Sketchy for Patho will
make you rely more on memorization rather than understanding and correlating
pathophysiology with other systems. Same applies to Sketchy Pharmac.

Pathoma:
Pros: A perfect tool for medical students to understand Pathology and its applications.
Dr.Sattar will make Histology slides easy to understand in a logical way. I guess I don’t need
to say anything more on this.
Cons: None
My Advice: Please don’t make mistake of doing all Pathoma at once In 15 days. Do it
system wise, if you are doing GIT then do only GIT related topics from Pathoma.
Start with first 3 chapters. Highest Yield for step 1. If you get sufficient time, try doing those
few days before the boards.

Boards & Beyond:

Pros: A perfect tool to help understand First Aid. To the point. Concise but at the same time
more than sufficient information to crack boards with flying colours.
Cons: You might find it very detailed and unnecessary in some topics.
My Advice: A MUST DO for everyone. If you want to do Endocrinology System then start
with reading FA briefly. Try to understand maximum what FA want’s to say. Try recognizing
bigger picture. Now watch a B&B video for that single topic. Understand and clear the basics
with the use of B&B. Add HY points of B&B to FA/Notes!

UWorld:
Pros: You will get to know how the facts from FA can be asked as a Question, thus
eventually you will know how to use FA. Helps you to build a question solving mind-set.
(How you should approach it and how not to). Also UW Facts, Charts, Images, Algorithms
are Highest Yield for Step 1. You may find a PDF of Charts/Images Offline in forum page.
You can do them in free time once you finish UW.
Cons: None.
My Advice:

This is a MUST READ for you if you don’t know how to use UW Properly or you are in a
dilemma whether you should reset it or not. I will put my perspective here, take what’s
necessary for you from this!!




http://www.agraphia.net/zac-fact-10-bigot-your-way-to-success/





First Aid Latest Edition:
Pros: Perfect book of 700 highest yield pages.
Cons: Because they have made it very concise, while reading it for the first time you might
feel odd and just descriptive. But, believe me it’s more than that. (Or you need to learn why
it’s more than just facts)
My Advice: This is a MUST READ for you if you don’t know how to use FA Properly.
For me, I didn’t read awesome authors for pathology, pharmacology or even physiology. For
people like us, First Aid is like “The Bhagvad Gita”. Because at this stage if we go back
and start reading Robbins or Guyton it would be impossible to appear in step 1 for at least 3
more years. FA gives you the topics you need to do in detail. I mean, if there and 100 topics
in total and FA covers 70, then you need to do those 70 in detail. Rest 30 are low-yield for
Step 1. You can trust FA blindly. 
So you need to approach the First Aid in Question Oriented Way, you need to know what’s
important and what’s not. If you don’t know this, don’t worry I will help you have an insight of
this. But you need to solve plenty of questions to get this mind-set.

Do FA “system wise”. If you are doing FA Subject wise, you are not getting 100% output
of your first aid as you will need to correlate between subjects & systems. See FA is just
compilation of High Yield concepts given in very concise manner. This means you will need
to “read between the lines”. You will need to understand why some facts are given as they
are in FA.

We all read, go through the same resources. But why does only some can break the plateau
and score desired results?
Well, the difference is in how they read and approach the same source.
So by the end of this 5 months, you have completely annotated FA with most HY Facts of
UW.

https://www.usmle.org/pdfs/step-1/content_step1.pdf
https://www.usmle.org/pdfs/usmlecontentoutline.pdf
https://www.boardsbeyond.com/step-1-tips
http://info.nbme.org/rs/343-IIB-826/images/IWW%20Gold%20Book_new%20cover_web.pdf

Know what you are going to have on exam, know what’s more/less tested on exam. So that
you can prepare accordingly.

So, your 2nd read of FA ends here.

Approaching FA this way will surely add many points. You might feel difficult studying
this way initially, but with the time it will get easy and you will automatically start
connecting the dots. If you aren’t satisfied with your performance at this stage, keep on
reading.

I am going to share you the biggest secret to score extremely high if used properly.
[This trick will help you a lot in NBMES. Because unlike UW/UWSA, NBME do not provide
necessary details to reach diagnosis every time]
 This method of using FA will surely help you secure your best if used correctly.
You will get better at making hypothetical questions & D/D as you solve more and more
NBMEs.

NBMEs:
Pros: I have emphasized enough on building a mind-set, which is impossible without solving
NBMEs inside out!
Cons: They do not provide you enough details to reach conclusion. Thus people who are
poor at memorizing HY buzz words tend to perform less on NBME & more on UWSAs
(which are more interactive) like Real Deal.
My Advice:








“Number of questions solved is directly proportional to your score”

“The Ordinary Experience” 
Exam Date: May 2nd, 2019
Score: 248
Duration of Preparation: Aug2017-May2019 (1 Year & 10 Months, with last 5 months Dedicated -
10-13 hours per day)

Resources:
 Kaplan 2017 (Biochemistry, Anatomy, Physiology, Pharmacology, Behavioural Science &
Ethics)
 UW Online 2018-19 (Used UW Online subscription for little more than a year)
 FA 2017, 2018 & 2019 (No matter how difficult you find to make a change to new version,
do it. You won’t regret doing this. Or have a PDF of latest FA with you, while you are at your
3rd read completing a system/day, go through the New PDF briefly and see the changes. Add
them to your previous version!)
 Pathoma
 Sketchy Micro
 100Cases+Kaplan BS
 UW Biostatistics
 Google Images and YouTube
 USMLE FORUM Pages

Struggle:
I don't want to brag about it here, as everyone preparing for this exam is going through the toughest
time in their life. Mine was much harder than one might guess as I prepared my entire MBBS
curriculum during those 22 months. 

Scores & Thoughts:

At the end of my UW+FA+Pathoma I gave NBME 13. I was hoping to score at least 225+ as I
had given my 15+ months of preparation time for this. But, I got this at the end of exam.
 NBME 13 - 215 (End of Dec ‘18) (I felt hopeless. Asked many buddies & seniors, they all
made me realise this was a good score for first NBME) (I was reading at home for 7-9 hours
in my comfort zone till now. It was NEW YEAR EVE, made goals and commitment for bright
future. Decided to join a library. After initial tough phase of familiarising with new place
started reading 10-11 hours)

 NBME 15 - 230 (Early Jan ‘19) (Revised half of my FA with FA 2nd Read method, got 15 mark
push. Felt great. I now knew that after finishing complete FA, I will get 240+ for sure)

 NBME 16 - 225 (End of Jan ‘19) (I did not improve. I was hoping to book a date if I cross 240.
But eventually I realised that 16 was realistic exam and I wasn’t prepared for this yet) (I
started to read many experiences online, searched what really is needed to cross 240. Came
up with this common idea, that Number of questions solved is directly proportional
to your score.) (Decided to give older NBMEs a try while I revise one more time)

 NBME 12 - 238 (Early Feb ‘19) (These were offline and just multiplied the score with 1.4, so I
knew this wasn’t the real score. And also these were outdated NBMEs)

 NBME 11 - 237 (Early Feb ‘19) (Offline) (Plateaued!!)

At this stage, my block was ending (Dec-Feb) so I started asking many people online on the
forum, they made me believe that this is my peak and I should give the Step 1 soon or I
might go downhill. I was not ready to accept this low! I have prepared so hard for this, I have
gave my all in till now, and I have sacrificed many things for this. So, I deserve better than
this. I trusted on myself and extended my triad to March-May and decided to give my FA a
"Thorough Read". This was different than just reading FA passively. (I have explained
this in How to Read FA for 3rd time section)
(Of course I didn’t know this method before. I acquired this by solving questions and reading
experiences online)
It took me 40 days to finish FA (completely annotated) once by this method.
During this time, after revising half FA, I gave NBME 17.

 NBME 17 - 248 (Feb End-Early March ‘19) (First time I crossed 240. Felt confident. Started
believing in myself & my technique of reading. Started giving NBME every 1 or 2 weeks)
 UWSA 1 - 258 (Early March 19) (I was on cloud 9!! Took a week-long unplanned break
during my Birthday week. A big-time no-no. Biggest mistake anyone can make during the
dedicated it a break of more than a couple days)

Came back from the trip and that wall of self-confidence was shattered. I felt I forgot all the
stuff I did until now. Started doubting myself and started feeling guilty of taking a break in
dedicated. Those all sacrifices till now went in vain. Thought that now getting even 230 is
hard. Gave me a full day to get together. And decided to give NBME 19, which at that time
was said to be toughest and most under predictor.

 NBME 19 - 242 (Mid of March ‘19) (Whoa, all the self-doubts were gone in the blink of an
eye. At first, I couldn’t believe that this was my score report. After a week-long break during
the dedicated, without studying any single page I gave the toughest exam and scored above
 my expectations. That made me super-duper confident, now I knew I would get 240+ any
day anytime. Now I started realising that what you do in long run matters. It’s not just
cramming FA gives you good score, but it’s your hard work and your hunger of clearing
concepts matters.)

Started solving older NBMEs. (Mistake!!) (I would suggest against it, as newer ones are
available now {20 to 24} and NBME 5, 6, 7 which I did were totally outdated compared to
real deal. I had on average 20 nice questions. Almost all of which gets repeated in newer
NBMEs. So if you don’t solve 1 to 7, it’s totally fine. Try solving 11 & 12 if you have time.)

 NBME 5, 6, 7 - 240-245 (April 19)

By this time, I started doing the FA one final time with 4th Read Method. Which again took
me 35 days to finish a read. I was constantly worried because my friends around me,
everyone I knew in USMLE Journey was finishing FA in 10 to 15 days in last phase. But again
I trusted myself. Kept on saying Quality > Quantity to myself. And it worked like magic
for me!! Gave a try to newly released and much awaited NBMEs.

 NBME 20 - 250 (6 weeks out) (Yes, I crossed “the 250s mark” in NBMEs)

 AMBOSS - 265 (5 weeks out)

Questions in this test were difficult.

They just overestimated the scores I
guess. As it was a free test, many
students in their initial phase of
preparation gave this test & got lower
scores. Thus that put us in Higher
range as scores in USMLE are just
percentile based, derived from that
cohort!
It was 87% correct in all 4 blocks
overall.
Anyways, this test boosted my self-
confidence to another level.
I started feeling that 250+ is of course
doable for me now.

 NBME 21 - 246 (4 weeks out) (I was not in “my phase”, was exhausted when I gave this.
After giving >10 NBMEs you now know if you gave your all in or not during the test! Also the
difficulty of questions were hard compared to NBME 13-17)
 NBME 22 - 257 (3 weeks out) (My Goal of getting “*” in each discipline was accomplished
now. I always wanted to make this “Before-After NBME Scorecard”. #Bragging ) (I started
feeling grateful about my journey and amount of progress I have made in last 22 months. I
was filled with gratitude for not giving up and kept on pushing myself till now)

 UWSA 2 - 258 (2 weeks out) (I was now calm, very calm. I knew I would get 250 any day
anytime!)
 NBME 18 - 248 (less than 1 week out) (I made many silly mistakes. #Rationalization 😀) (So
the real reason why my score dropped was I gave 3 Blocks of UW first & then NBME 18.
Basically I did not focus on giving 8 hour exams till now. “A Mistake”. In last 2 blocks I was
completely drained) (You can still trust "the18" for realistic assessment)

This last few days I did ECG, Heart Sounds, X-Ray/CT for which I made UW Flashcards and
revised Biostatistics+Ethics. [Use DirtyUSMLE Videos for this!]
Now I was left with 3-4 days. As I started my final read 35 days back now, I had self-doubts
about my memory. So cleared them by reviewing “ONLY the HY facts from FA”. (Charts &
Tables only)
2 Days before exam watch this Video: https://www.youtube.com/watch?v=zJgjMZk8_To

 FREE120 - 111/120 (93%) (Gave it a day before the exam to familiarise myself with Exam
Pattern & User Interface. “Recommended”) (I solved it briefly, read few volatile topics, took
the rest day off after 3PM. “Highly Recommended”)

When you will go to their website, you will find this.

http://orientation.nbme.org/Launch/USMLE/STPF1
First start with Tutorial. Then Overview. And then go
with Step 1 All blocks. And in that start “Enable
Timer” mode. You won't get answers after each
block, they will just show percentage correct. See
other attachment in next page.
You need to do individual blocks again, with “Show
Answer” mode to see answers after every question.
 Official STEP 1 – 248 (Breaks were 5-5-7-10-10-12-rest) (Experience: Woke up at 5 in the
morning. Gratitude Routine. Light Breakfast & Mild coffee. Reached the Prometric at 7. After
usual check-in procedure, my test started at 7:15. First 2 blocks were awesome, was left
with 15 mins in each, and double-checked every answer in those. 3rd block was horrible for
me. Marked more than half questions. Was unsure about almost all questions. Rest all
blocks were similar to 3rd one but less extreme. Main reason I could think of getting 10
points lower than my expectation, was my performance in last 2-3 blocks. I was almost on
Auto-Pilot Mode, I was just reading & answering. I was not 100% focused in those. This is a
Major Factor affecting anyone’s score. I would highly recommend giving at least 3-4 full time
tests to boost up your stamina.)

Post Score thoughts:

 Anyone* can do it. *with dedication and persistence.
 Use NBMEs just to assess how prepared you are, don't make false hopes/don't get nervous
based on the NBME scores. I have seen people getting excellent scores on NBMEs & getting
below average in official & vice versa.
 Don't be afraid to delay the exam. Trust yourself.
 Keep on learning & clearing new concepts till the last day of your exam.
 Your Approach and Attitude towards USMLE is everything. Try to stay a step ahead, a level
above the examiner. You should be the one who rules, not the exam!
 Start believing in you, you know what’s best for yourself. Don’t ask unknown persons on
forums. Be your own Judge!
 Don't take more than a couple day break during dedicated. (After you start feeling you have
got this!)
 Keep on answering questions on Forums. You are helping yourself by helping others!
 Don't compare with others. Their journey is different than yours. (For a kid like me 230s
were great score & for a throughout ranker even 260 is lower. So don’t let other people say
what’s best for you)
 Don't let anyone tell you, you didn't study till now so you can't do it.
 Be willing to give up all the distractions and all the extraneous unnecessary things for this. It
will be worth giving up outings/movies/parties and what not. (I gave up on all social media,
including Whatsapp to add 1 more hour to dedicated study! I don’t regret doing it.)
 If you have got a dream, protect it. Period.
 Last but not the least, all buddies preparing for step 1 right now, reading this right now, if
you are going through a hard time in life, just thank yourself & be grateful that you didn't
give up till now. Just be consistent, persistent & patient. And always remember, Hard Work
Pays Off. #HWPO
This PDF is the result of my persistent efforts at helping fellow students. If you have found
this experience helpful in any sense, kindly share it with your near & dear ones.

This line has always motivated me throughout my journey.

“If you don't fight for what you

want, then don't cry for what
you lost”

Thank you for your precious time for reading this long one!

Regards,

Dr. Birju D. Patel

Smt. NHL Municipal Medical College

E-mail: doctorbdp@gmail.com
Skype: b4birjupatel

Ahmedabad, GJ, India