Took the beast today and have some thoughts that I feel compelled to share given I had the same doubts/questions/fears regarding it:
1) UW vs NBME vs Step 1?
I wish I could say a specific answer but I honestly felt that the test was a combination of the two. The easy questions (roughly 20-25%) of the exam were gimmes like on NBME and the medium difficulty questions (about 50-60%) were either slightly vague in their presentation like NBME or required more higher order thinking/deducing like UWorld. The truly hard questions (around 10-15%) were hard because either they went more higher order than UW, asking about connections between topics that required very solid understanding of pathophysiology and being able to apply concepts to novel situations. The true WTF questions for me honestly felt experimental, asking about very minute gene details regarding a common disease or very obscure anatomy or a very random biostats concept. But these WTF questions honestly were only a handful and some.
In general, majority of the questions had around 4-5 answer choices and I had some questions where I didn't know much about the topic but I could definitely rule out the answers down to 1-2. I will very surprised to find that the vast majority of question stems were more like NBME in that they were
SHORTER than UW (yes I know!). There were probably 5-8 questions with true long stems but they were usually psych/ethics questions. That being said, I found myself using every minute of every block solely because I spent a lot more time pondering each question than I do on UW/NBME.
2) Breakdown of topics
- Anatomy: Comprised a decent portion of the exam, more than I truly would have liked and more questions than my friends' had on the topic. That being said, it was not bad for the most part. I luckily did not have ANY tough female repro anatomy, which made me VERY happy. 85% of the anatomy consisted of things mentioned in UW/FA/NBMEs (KNOW those UW Anatomy pictures! They are gold!). The other 10% was not in there explicitly but could be somewhat reasoned out. I had one question on a topic that I vaguely remembered encountering in my sh**ty class lecture 2 years ago.
- Biochem: Wow, this was the biggest shocker. My biochem questions were by far WAY, WAY, WAY easier than I expected. I was pleasantly surprised because I feel emasculated every time I study Biochem and I came out feeling like I spent much more time on it than I needed to on it. The type of questions on my exam were much more broad and "overall picture" based than most of the Biochem questions I encountered on NBMEs/UW. That being said, my exam may not be the same as yours, so still study hard!
- Cell Bio/Molecular Bio/etc: I will say that most of the toughest/WTF questions I had on my exam probably came from this section. I would say know FA/UW cell bio stuff well (I think FA covers it a bit in the Biochem section) and also as you are learning the pathology of each disease, be able to integrate how cell bio pathways play into the pathophysiology of the disease as they are asking more and more types of questions like this.
- Physiology: Hard. But fair. Felt a lot like the newer NBMEs and questions from a certain qbank (read on). Those up-down graphs that we so look forward to (sarcasm), yeah they showed up by the bunches. FA/UW/past NBMEs are a solid way to prepare for the physiology on Step 1 however. Throw in BRS Phys for topics that you find difficult (BRS does a great job on hemodynamics btw). And with that, here's my kicker: Walking out of the exam, I felt that the best resource that helped prepare me for these up down questions that were so prominent on my exam were.......... <drumroll please>
Kaplan QBank questions. I downloaded an offline pdf of Kaplan QBank (from 2012) phys and pathophys questions and did around 70% of them every once in a while during my rotation last month (bc FA was lulling me to sleep) and without a doubt, I believe they gave me the best
"feel" of the type and difficulty of questions on Step 1. Now, I know Kaplan is notorious for having minute details but tbh, those questions were few and far between. Kaplan phys questions were generally harder than the ones I encountered on Step 1 but they drill the hemodynamics stuff down hard. Definitely know your volume states and body responses, as well as hormonal responses in common pathologies.
- Pathology: Not entirely bad. Lots of integration with other topics listed above but the pure pathology ones were usually the gimmes. UFAP was by far the highest yield. I will say that they tended to ask the more obscure/less commonly encountered diseases in a more straightforward fashion and they asked the common diseases in such a way that you had to have a thorough understanding of the ins and outs. My exam had a ton of renal/GI and less female repro (*YES!) and neuro, but yours may vary. I had a ton of pictures, but they were straight forward for the most part. 1 pic was a repeat from NBME.
- Micro: Parasites fo' days... Good lord, I have a theory those NBME test writers watch Sketchy in its entirety and purposefully ask questions not mentioned it. No, I am not trying to freak you out. Sketchy is gold but DO NOT IGNORE FIRST AID! I only had about 5 gimme questions in Micro that could be answered solely by Sketchy. The rest were organisms that could have been found in Sketchy but had pictures and descriptions that Sketchy alone would not have led me to the answer. KNOW THOSE DAMN PARASITES! I had more parasite questions than virus questions and I was livid. Also, KNOW HOW THOSE DAMN PARASITES LOOK LIKE. I had 4-5 Micro questions with a vague AF prompt but a picture that led me to the answer. I made a quizlet with pictures of all the parasites and hit them hard about a week ago so I felt kind of, sort of prepared. But I am still clueless on one of the parasite questions.
- Pharm: Not too bad at all. Very high yield side effects. UW + FA more than enough. Only 1-2 were ones that made me go WTF. Without breaking NBME rules, I will say know some "atypical" drug names of the common drug classes like diuretics or etc. These will help you rule out answer choices for the harder questions for sure.
- Psych: Straight-forward. Like UW for the most part. All of my questions came straight from the FA chapter, which is underrated imo. Know the drugs too of course.
- Next step management: These were medium/hard. I had 4 questions that I was only able to answer because I came off of a 2 month internal medicine rotation recently. In general, pick the most straight-forward answer. Similar to NBMEs/UW but some had a few had situations I could not have imagine. I felt very unsure on a lot of these.
- Biostats: Not that many questions, 2 tough ones. Watched 2 Dr. Randy Neill videos on YT and one B&B video on bias and read the FA chapter the day before exam. Felt like I got every one of them, thanks to those two. I have some background in statistics (AP Stats in high school lol, but taught by an exemplary teacher) and had a well-taught biostats course at my med school so I never felt too uncomfortable. But Randy Neill and B&B were excellent reviews.
- Ethics: By far the hardest part of Step 1 imo but luckily compromised about 5-6 total for me. I had scenarios with 2-3 answers that seemed perfectly reasonable. For this reason, I felt the most unsure on these questions. Just made the most reasonable choice that my gut told me to pick and went with it. FA/UW didn't help that much. Read Conrad and a few other online sources, but they didn't seem to help much either. This is one section that I cannot say with certainty which source to use.
3) General advice that I'd give to myself when I started studying:
- KNOW the buzzwords (with a caveat): Yes, Step 1 had a TON of buzzwords. But the vast majority of the time, they were presented as clever "descriptions" rather than the words themselves. If you've done UW/NBMEs, then you'll know what to expect. I sometimes caught buzzword descriptions on a 2nd closer reading of the questions that I missed on my first. So simply, KNOW buzzwords and use reading comprehension skills to recognise them when presented slightly different than what you may be used to seeing in FA/UW.
- Practice your rule out skills: A lot of questions I encountered today had very similar case presentations but there were key phrases (sometimes one word) that helped distinguish between one pathology and another. So as you are learning the common diseases, ruthlessly focus on being able to distinguish one similar disease from another. UW obviously helps a lot with this. FA charts and the way they have all related diseases one on pages makes it easy to find differences too. Even many of the tough questions had answers that could be EASILY ruled out, thus raising the chances of me answering it correctly even if I guessed. This is an innate part of test taking ability than can only really be practiced in its most direct form by questions, questions, questions. Be ruthless in your wrong answers and try to never get that particular concept, question wrong again.
- BECOME AN EXPERT on the most common diseases. The biggest thing I got out of today was that Step 1 tested the more vague diseases in a simpler fashion but for the common diseases (ie DM, HF, etc), you had to truly understand the pathophysiology inside-out, frontway-backways to be able to answer them. Never skimp on the common diseases because you think you know everything about it since it's so common. Become an expert on them and be able to thoroughly explain how those common diseases cause the clinical manifestations they do. Knowing the common pathophysiology will also help to answer questions on scenarios never encountered before.
Long read, but I just threw my thoughts out there as a much needed release. Hope it's helpful and as always, YMMV.
*My background:
- NBMEs started in 220s, 230-40s towards end (but I still hate you NBME 19), UWSA1 high 240s a while ago, UWSA2 250s a week before.
- Did FA, UW, some Pathoma. Some Kaplan QBank due to FA boredom. About 60-70% of USMLE-Rx, didn't find that helpful imo.
- Listened to all Goljan on commutes a while ago, moderately helpful.
- Did a few chapters of
Robbins Review of Pathology question book questions. This book is honestly gold but I didn't get much time to do it. I wish I had finished this in its entirety before dedicated. Definitely picked up some pathology concepts + question reasoning skills from it. Explanations of the utmost quality, on par with UWorld.
Sorry for long post but good luck to those who have yet to take it! See you soon on the other side. There is a light at the end of the tunnel, along with some ice cold beverages metabolised by CYP
*EDIT: Someone asked about the Parasite quizlet I made and I figured I'd just share it if anyone would like to study from it. I tried to include pics of the parasites but also know what the worms look like grossly (yes I'm serious).
Glycogen/Lysosome storage diseases + Parasites Flashcards | Quizlet
^ Btw it's Parasites and Lysosomal/Glycogen storage diseases combined because I combined the most rage-inducing topics into one.
P.S. f**k NBME 19's curve
