I've used this thread and forum a lot to compile advice throughout medical school. Here's my attempt to pay it forward.
TL; DR
Learning the material well during 1st and 2nd year coursework is paramount to success on Step 1. Above all else, it’s my sincere belief that this contributed to my score the most—without that initial investment, reviewing would not have been nearly as productive. Supplement studying during systems with Pathoma and Sketchy Medical as they are pertinent. My recommendations for board-specific study are as follows: complete all Kaplan questions along with their respective system (e.g., cardio during cardio). Finish Kaplan by the end of winter break (5 months out). Start USMLE Rx, completing 25-50 questions per day. Finish Rx by the end of March (2 months out) and begin UWorld. Complete 40-80 questions per day and finish UW a week before test day. Track your questions and percent correct using Excel and aim to complete around 10,000 questions total. The last week should be spent reviewing weaker topics, reviewing Sketchy, and doing Anki cards if you have them. Sprinkle in all the NBME practice exams and UW self-assessments to track your progress along the way.
Scores
I found it helpful (if only to ease my anxiety) to compare my scores to those of students in prior years. This can serve as a general gauge as to where you stand, but by no means should you consider it precise. Performance on test day relies on a decent amount of luck (between sleep, stamina, questions aimed at your strengths, etc.). Sometimes the chips don’t fall your way. Better to be over prepared and get unlucky than to be under prepared and get unlucky.
Kaplan (throughout 2nd year, finished in early January): 64%
USMLE Rx (January and February): 74%
UW 1st pass (started beginning of March, finished end of April): 70%
UW 2nd pass (only about 1000 questions): 84%
NBME 13 (12 weeks out): 221
NBME 15 (7 weeks out): 240
NBME 16 (5 weeks out): 234
NBME 17 (4 weeks out): 240
UWSA 1 (3.5 weeks out): 251
COMSAE D (3.5 weeks out): 659
UWSA 2 (2 weeks out): 247
NBME 18 (5 days out): 257
USMLE: 238
COMLEX: 765
Addendum: I’ll also comment on the correlation between MCAT and Step 1 for those that are interested (I know that I was). MCAT and Step 1 are drastically different exams. The MCAT felt like it relied much more on test-taking ability, whereas Step 1, while also relying heavily on testing abilities, relied much more on your foundational knowledge of the material. I applied to medical school with a 30 on the MCAT. I say this to acknowledge that I’m not inherently “good” at taking standardized tests. I did not do well on the SAT either. But as you can see, a 238 on Step 1 is a significant improvement relative to a 30 MCAT (30 on the MCAT was well below the mean of 33 for accepted MD students, whereas 238 is well above mean for MD students on step 1). This is important because you should realize that your MCAT score is not destiny—if you felt discouraged by the MCAT, know that you can work hard and learn the material well and still succeed on Step 1. By the same token, just because you did well on the MCAT does not mean that you are “guaranteed” a high score on Step 1. This exam requires preparation and understanding of a large swath of material, and while test taking abilities will certainly help, they are not entirely sufficient.
Systems Coursework
Learning the material well during 1st and 2nd year courses is by far the best preparation for boards. I had a general plan of attack that I followed for each system. First, watch Pathoma before any of your pathology lectures. I preferred watching these before learning the material because Dr. Sattar does such a fabulous job at explaining pathology, even as an introduction to the material. Try and follow the mantra of preview, learn, review: preview the material (Pathoma), give yourself a day, learn the material (read about the topic in your class notes/textbook), give yourself 2-3 days, then review (notes, review book, Anki, etc.). This allows your brain to synthesize and store the information in a manner that is most efficient and longest-lasting (spaced repetition). After watching Pathoma I would wait a day (if time permitted, which it wouldn’t always) then study the material from our class notes/Robbins. I would make Anki cards on the 2nd pass of the material. Then, after a few more days, I would continue to review the material via synthesized notes and reviewing Anki cards. Rapid Review Pathology was also very useful at this review stage. I would watch the relevant Sketchy Medical videos as the topics arose. Towards the end of each system I would complete the Kaplan questions specific to that system.
Board-specific prep
Aside from the Kaplan questions at the end of each system, I would not recommend doing any board-specific studying until about December of 2nd year. At that time, I set a goal to complete the remaining Kaplan questions by the beginning of January. Once finished with Kaplan, I began doing about 25 questions/day (always random, timed) from USMLE Rx with a goal of finishing them all by the end of February. In the beginning of March, I started my first pass of UW, doing 40-80 questions per day (random, timed). I would spend an hour doing a set of 40 questions and about 2 hours reviewing the questions (referencing topics in FA/Pathoma). After finishing the first pass, I started a second run-through towards the end of April, with the intention of taking the exam early June. We were practically done with school mid-May, so I had 2-3 weeks of uninterrupted study time. This was more than enough (literally, I wish I would have taken the exam a week earlier) given the preparation that I had been doing all year.
Don’t fall into the trap of “I’ll review all of FA and then start doing board questions”. I know it’s tempting, but this is not an efficient way to study. Doing board questions will quickly identify knowledge gaps, whereby you can use FA to fill in those gaps. Passively reading FA will not accomplish this. I spent about 90% of time doing board questions and 10% strictly reviewing (e.g., reading a FA chapter). By doing board questions, I mean spending a decent amount of time reviewing topics (in FA) as they come up in your question sets. For example, if I missed a question on Parkinson’s, I would review the FA section on that topic and the related neurodegenerative disorders. But I practically never just sat down to review a FA chapter.
Having watched all the Pathoma chapters during my coursework was very useful. By the time “board studying” came around, I had already been through the chapters once, and watching them a second time allowed me to synthesize all systems and pick up on minor details. I highly recommend this approach. As boards approach (1-2 months), start trying to identify topics you feel need more work than others. Spend review time going over these chapters in FA/Pathoma/RR Path and making Anki cards on material you feel is pertinent.
In terms of COMLEX-specific prep, I did very little. I bought the obligatory Savarese Green Book, which was useful if you want to be very good at OPP. However, it is by no means necessary to succeed on Level 1. I did not review any of the chapters in Savarese and I only completed the first of five practice exams in the back of the book. I also did about 1000 questions from COMBANK and was averaging 75%. These were useful in terms of exposing yourself to the COMLEX-style question format. I would recommend doing at least 1000 of these questions before taking COMLEX. You’ll pick up all you need to know from the OPP questions they have. OPP never struck a chord for me. I didn’t do well in it during our coursework, didn’t spend a lot of time studying it for boards, and as you can see, my score didn’t suffer because of it. Don’t spend a lot of time stressing about OPP—the questions on the boards are very straight forward. Doing UW helped me build a foundational knowledge that earned me more points on COMLEX than anything else. Even if you plan to only take the COMLEX, I strongly suggest doing UW. The questions can be frustrating, but even if you are doing poorly in terms of percentage, you will be amazed at how much you’re learning. When I went from UW to COMBANK, the questions felt like absolute soft tosses. This translated over to the Level 1 as well, where I felt the caliber of questions was far easier than those in UW or on Step 1.
Advice by virtue of hindsight
Your success does not require that you follow in the exact footsteps of any one student who went before you. I hope that you can appreciate the methods that I used and create a study plan that works best for you. But I cannot overstate this enough: questions, questions, questions. These should be the foundation of your studying. No exceptions. I completed a little over 10,000 questions in total. If I were to do it all over again, I would change only a tiny portion of what I did. The main thing that really stands out to me was my attempt at a second pass of UW. While many people on SDN said that this was worthwhile, I’m not sure that I completely agree. I only did 1000 questions on the second pass because I felt like I remembered too many of the questions. It wasn’t that I necessarily remembered the exact question/answers, but more that you kind of have a feeling about the premise of the question: “I feel like this was one of the trick questions” or “I don’t remember x being an answer, so I’ll rule out that answer choice”. I think this drastically dampens the power of UW. If I had finished UW about a week before taking Step 1, I think that would have been better for me. Plus, it was very time-intensive to complete all 3 questions banks in one semester, let alone try and do UW twice.
Other than that, I have no regrets about my preparation. I felt well-prepared going into test day and for beginning clinical rotations. As for the apparent discrepancy between my practice scores, step 1, and level 1 scores, I have a few thoughts on what happened (not making excuses, just providing advice to others on what to avoid/watch out for). The 257 on NBME 18 may have just been a lucky test. I only missed 12 questions if I remember correctly, but a friend of mine missed something like 18 questions and got a 245. As you can see, at the upper scores, the curve is very steep. I could have had a good guessing day, or a handful of difficult questions could have been more suited to my strengths. Same goes for test day—there are only 280 questions on the exam, so it’s easy to see imagine if you get unlucky or make bad guesses on a handful of questions, that could drop your score significantly. I was also not able to sleep the night before the exam. Talking with friends and those on SDN, it seems that this is not an uncommon occurrence, as one might imagine for an exam that purportedly determines the rest of our career. I didn’t feel that tired on test day, possibly due to the adrenaline flowing strong, but one can’t the effects that sleep deprivation has on decision making. These are obviously “what if” arguments, but my point is that you should do whatever you can to ensure you get a full-night’s sleep before exam day. Adequate sleep can only help.
My point in acknowledging what may have happened is to help others establish realistic expectations of what might happen on test day. You may get exactly the average of your test scores. You may score well above, or you may score well below. Using practice tests should strictly be an approximation—never taken as destiny. In the end, I’m glad that I studied as hard as I did, performed like I did on practice tests so that even in the instance that I “underperformed” on test day, I still earned a 238 (which will certainly only help my application). I would recommend doing everything in your power to ensure you are over prepared so that you can weather a bit of the uncertainty inherent to standardized exams.
