Took the test in June 2005. I spent 6 months studying regularly for the exam. I spent 6.5 weeks after my last 2nd year classes finished for focused studying in preparation for the exam.
The exam level of difficulty, in a nutshell, is dependent on how much you study. As Goljan once told me, "The more you study, the higher your score. The less you study, the lower your score." I feel that 4 weeks as some people choose would not have been sufficient, at least not for me.
I was an average student throughout my first two years of medical school. My last half of the second year I committed myself to board preparation above class grades (in essence, I actually performed better than ever my final semester!). As others have said, I too was not the greatest student my first year. I found great difficulty learning anatomy and I believe it was my weakness (especially neuroanatomy) on Step 1. I did not study between first and second year. I tried to learn pathology and microbiology very well during the fall semester of my second year.
During my second year, I studied much more than first. I studied almost every day of the year (even Fridays). I tried to do very well in my second year courses (and did compared to first year). My top resources for each subject are as follows:
TOP OVERALL RESOURCES:
1) First Aid for the USMLE Step 1 (my own content added quadrupled the amount of information)
2) Kaplan Qbank (better than you think...used for learning, not necessarily for mastery)
3) Goljan (wow)
Anatomy: Most is in FA...Moore's Clinically Oriented Anatomy helped for many of the innervation of the hand questions
Histology: High Yield Histology is a great book.
Neuroscience: High Yield Neuroanatomy is not enough...need more imaging references (CT, MRI, etc.)
Embryology:First Aid sufficient
Physiology: Basically all physio was tied into pathology.
Biochemistry: Many questions just listing an intermediate in a pathway (easy if you have memorized FA)
Pathology: If you read Robbins, you are golden. Pathophysiology is the name of the game.
Genetics: Know the classic associations with pathological conditions (involving chromosomal abnormalities).
Molecular Biology: Quite a bit and not in any resources (including HY Cell & Molecular Biology). Know your weird genes involved in embryology.
Microbiology: classic associations you can memorize in FA
Immunology: Know this cold (end of FA section of microbiology); know immunodeficient states and how to treat (i.e. AIDS patients)
Behavioral Science: Surprisingly more difficult than Qbank...HY is a good source.
Pharmacology: FA (I didn't believe anyone when they told me this before...it's really all you need)
I used First Aid and annotated it as I read the information in other sources (High Yield, BRS, etc.). I annotated even those points that I knew cold...because you will forget! I did the Robbins questions and the Qbank questions. Appleton & Lange were rubbish in my opinion.
The NBME exams were good for learning how the test questions would be written. There were "buzzwords" but not many. Sometimes the buzzwords led you astray however, so be careful. There's a lot of reading passages and determining endocrine hormone levels (usually up or down arrows). For pharm, side effects and antineoplastics were big. I thought neuro was the toughest subject so in retrospect, I wish I had studied it last. Biostats was poorly represented and did not seem difficult compared to Qbank.
Time was an issue on the exam. It was tough to get all the questions in during the block for a few of the blocks but others were less time consuming. I think it was just luck or unluck of the draw. Work fast and efficient. In terms of overall time, I just snacked in between sessions and left a lot earlier than anticipated.
I enjoyed the experience (though it was tough toward the end) and am glad I have faced Step 1. I believe the core knowledge I gained in preparation for that exam is helping me day in and day out as I deal with real problems in real patients. Medicine is very fun once you understand the reason behind what you are doing. Good luck to everyone taking and preparing for the Step 1. It is a grueling and sometimes daunting task, but with a little bit of elbow grease and hard work, it is manageable. If you feel distressed, just keep studying. Instead of stressing the last day while sitting at home or lounging, I kept studying. I studied right up until I went to bed. I was tired and I went right to sleep. I woke up the next morning and felt very confident and ready to take the exam. It felt good knowing that I had prepared well and knew I had an edge on the testwriters. I'd like to thank everyone on SDN for the support and help.
