How I Went From a 499 on the MCAT to a 254 on Step 1

Updated: Feb 6, 2019


A brief introduction first; I’m Mike, a third-year osteopathic medical student at LECOM. I scored a 254 on USMLE and a 790 on COMLEX this past May. I always had extremely high ambitions of being able to score that well, but I was never quite sure it was possible for me. Reading through many of the Step 1 posts on various blogs and forums, I often had the impression that so many of the high scoring students were always destined to score that well based on the high-ranking school they attended, their MCAT score, credentials, or even the very extended dedicated period they had to be able to focus solely on Step 1. I had none of these things. I scored a 499 on my MCAT; I did not have any sort of dedicated study period, and I do not attend what would be considered a high tier school. Through the course of hard work and proper preparation, I was able to remodel my thought process and improve my test-taking skill. I’m here to say you are more than capable of doing the same and achieving your ideal score.

Now, back to what you care about. How do I do well on USMLE and what resources are best? If you ask ten different people, you’ll get ten different answers. Ultimately, you will need to take time to decide for yourself. This is a crucial step that is often overlooked. What tends to happen is you either end up overwhelming yourself with too many resources or select too few resources and end up deficient in certain areas. In between these two exists a happy medium that only you are able to find. I hope by sharing the following about my Step 1 experience, that it helps you to navigate yours.


I started supplementing class material with what would be considered board review material by the tail end of the second semester of my first year. This is when my school finished up the core science classes and we started blocks of organ systems. For microbiology and pharmacology, I used Sketchy Medical and for pathology I used Pathoma. In addition, I used Boards and Beyond to gain a general overview for each system and First Aid as a quick review prior to an exam. Lastly, I used the USMLE RX question bank alongside each of our blocks.

Although class material parallels what is considered to be “board relevant,” it often leaves out concepts and facts needed for Step 1. Failing to introduce these in the corresponding school block leads to unfamiliarity and difficulty when trying to review for Step 1. The only way to know what might be missing is by using resources like First Aid and the others mentioned alongside each of your school’s classes. The length of your dedicated time to study for boards will vary based on your school. I had roughly a week and half from when I officially finished classes to the time I began clinical rotations. Yikes. However, knowing this, I began reviewing material for boards just a few weeks after starting classes second semester of my second year. I started with the general principles section of First Aid and progressed into each of the systems using the same exact resources I had used all along. I took each section a week at a time and at the end of each week, I used the Kaplan Question bank to access my knowledge and retention of the reviewed system. By the end of March, I had finished what would be considered a “first pass” through all of the material. I then began UWorld in untimed random mode.

My biggest concern with USMLE was trying to remember what I needed to answer a question when any system was fair game. Random mode accomplished this task by keeping me from instantly eliminating answer choices based on knowing what organ system I was in. Six weeks later, I finished the UWorld-approximately one month away from USMLE and COMLEX. From there up until test day, my studying consisted of taking all the NBME forms (13-19), both UWORLDS self-assessments, and my school’s required COMSAE and COMBANK tests. I used these to judge my level of readiness as well to see as much variety in question stems as possible. I concluded my studying a few days out by just briefly touching base on biostats and some last-minute things I wanted to see one more time.

Resources:

Sketchy Medical: My bread and butter for micro and pharm. I really hammered the sketches into my head, watching them multiple times during the core classes and each relevant system. By the time I was exclusively studying for boards, I spent very little if any time reviewing micro and pharm. These ended up being two of my best scoring subjects.

Pathoma: I made almost a full pass during my core pathology class and then passes of each corresponding section during systems. I made a pass through when specifically studying for Step 1 and then also reviewed the first 4 chapters a few days out from the exam. The first 4 chapters contain some high yield, basic pathology, and I strongly recommend reviewing those first 4 chapters shortly before exam day.

Boards and Beyond: Video-based lectures similar in structure to Pathoma that go over just about every topic you can find in First Aid. The lectures are easy to follow, concise, and a great way to learn new material as well as review various content later on. I personally found it best to watch the videos prior to reviewing the content in any text-based source.

First Aid: As previously mentioned, the controversy lies with when to begin using it. My approach was I bought the current year FA once we began blocks and annotated it with relevant class material. I used it to hone in on important concepts throughout a block and as a quick review prior to a test. When I started specifically preparing for Step 1, I purchased the most up to date edition and exclusively annotated it with supporting material from UWORLD and Pathoma. My mindset was that my class annotations were no longer board specific and I wanted a fresh, up to date copy to add any additional information from those high yield sources not found within the text.

Anki: I found Anki (spaced repetition flash card app) very useful for trying to really get down hard to remember concepts or minutiae that wasn’t best studied in other ways. I exclusively used the Zanki deck and did not make my own cards. Overall, I was able to get through about half the deck as I only began using Anki midway through my second year. In retrospect, had I started on early on and kept up with my reviews, I believe it could have been an even more powerful tool for high board performance.

Kaplan Question Bank: I thought it was very valuable as a first question bank if you have the time prior to UWORLD or perhaps, as a second question bank after if you find yourself stir crazy. I thought the physiology questions were top notch and very useful for my actual Step 1 exam.

UWORLD: I really liked my approach using UWorld random mode and as my major source of studying coming down the home stretch. It felt like I was doing another pass through all of the material, just in a different modality. Also referencing FA or other supporting material really helped to solidify any lingering difficulties.

NBME Self-Assessments: I really recommend trying to take all of the NBME and UWorld exams. Variety in question stems allows you to see many of the different ways’ concepts can be tested. In addition, I felt I had almost identical questions on Step 1 as the questions on some of the NBME’s, making the assessments seem like freebie questions come exam day.

Final Words: In summary, try and start early if you can; Formulate your plan, stick to it, and work hard. You got this!

Mike Driscoll is currently a third-year medical student at LECOM. He tutors for the USMLE Step 1 with USMLE Pro Tutors.


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