How I scored a 272 on the USMLE Step 1

USMLE Step 1 Experience

272
100th Percentile

As others have done; I thought I would do a quick write-up of my experience on Step 1. To be honest, there is not much unique that I can tell you, but I thought I would give an overview of my resources and general strategy anyway.

Background


I seem to be one of the odd people that actually enjoyed the first two years of medical school. I did well; Honors in almost all classes (except Gross Anatomy). I see a lot of students focusing only on the “high yields,” but the truth is if you want a 270+ score you need to put the time in to learning the minutiae as well. Doing well in classes is a great way to do that.

Throughout the first two years, I think annotating FA is very important. It helped me condense all the information and made review much simpler. I do not really believe in “saving” questions for the end. Start doing questions as soon as possible. If you do want to save UWorld for the end, that’s fine, but I would recommend starting a different QBank earlier and following along with classes.

Step 1


Overall, my impression of the exam is that it is very similar to the NBME practice and/or UWorld. Expect a ton of pathology and physiology, most of it very straightforward. A few tricky questions, but don’t psych yourself out. If it makes sense, it’s probably the right answer (although logic can sometimes lead you astray as well…). There is a lot of microbiology and immunology mixed in. Biostatistics is also very high yield. I will once again say that doing well in classes and having a strong background in the basic science of medicine is the best possible way to prepare. So keep in mind; everything is fair game. Ultimately, most of the questions I missed were little details that are not covered (or covered very briefly) in FA or QBanks. Overall I think the hardest for me were the physiology questions. Know your up/down arrows! Especially when it comes to cardiology, endocrinology, and renal. Drug side effects, limitations, and interactions will definitely show up so start learning them early. There were a few questions on each block that I was unsure of. Some more than others. I ended up looking up the answers to about 15 questions, of which I missed 5. I’m sure I missed many more throughout that I didn’t realize. Timing was never a problem for me. I could finish a block of 40 questions with 20 minutes or more left in the hour, which left me plenty of time to go back and think about the marked. I did not really plan my breaks beforehand, just left to eat when I was tired or hungry (I believe it was 3 blocks, then 2, then 2 more). I left the exam feeling pretty good. I knew I missed some, but expected something >260 at least.

Subjects


The following advice pertains mostly to those starting early. Skip forward if you only want information on my dedicated review or advice for test day. I italicized the resources that I found most helpful.

Anatomy – Do as many questions as possible. I spent way too long staring at structures in class and in lab early on in the semester. I actually did all of BRS Anatomy in my dedicated. I don’t think it got me any questions, but it helped me feel a little more confident. Definitely know the QBank questions and what is in First Aid.

Biochemistry, Genetics, Cell Biology, Histology –QBanks and FA should be sufficient. Cell biology is more high yield than biochemistry. Know how each fits into different diseases.

Microbiology and Immunology – Questions. Looked over my previously made bug charts. These are very high yield subjects, so try and get a good baseline during the school year.

Neuroanatomy – Just questions during dedicated review. During the class I used Haines Atlas and Draw It To Know It. I found both very useful, and neuro was one of my best classes.

Pharmacology – Reviewed my drug notes (made by cross-referencing FA with class notes). I used QBank questions during dedicated as well as Thieme Pharmacology Test Prep during the semester (highly underrated book).

PathologyPathoma and Goljan are both fantastic resources that you all are familiar with, so I will not expound their virtues here. I completed each once. Pathoma before learning each unit, and Goljan while walking to class (neither during dedicated). I also read Pathologic Basis of Disease for most units (yes, the big one), and completed the Robbins Review of Pathology questions (my school included questions from the book on our exams). Finally, I did QBank questions for each unit. I cross-referenced each resource with FA. Some might consider this resource overload, but I found going through each became progressively easier as I understood the material better.

Dedicated Study


First Aid – I didn’t “read” it during dedicated, but that was because I already knew it so well. I could flip to the page for any disease or drug, and I had it heavily annotated. Definitely a necessary resource.

QBanks – I completed UWorld, Kaplan, and USMLE Rx. Rx is the easiest, but good if you want to be walked through First Aid in question format. UWorld is the classic. Kaplan definitely has some worthwhile questions if you have extra time.

NBME – My school had us take the CBSE in January (way too early; before having done our cardiology, pulmonology, GI, reproductive, or renal blocks). I scored a 91 (roughly 250). I completed all other NBMEs through Spring and my dedicated. Unfortunately, my score didn’t move too much, but roughly stayed within the 265-275 range. I would agree that these are very predictive.

After my end of the year finals I created spreadsheets for each subject where I would record facts from questions that I missed on my finals and all the questions I did during dedicated review. I went over the sheets the day before the exam when I didn’t feel like doing questions anymore.

Conclusion


I realize this may not be a great guide to success on Step 1 for everyone, but I hope my writeup can add to the collective knowledge. It may seem like a lot, but I still had a life throughout all of it. I have a girlfriend, work out regularly, listen to music, and waste time on reddit. Find a strategy that works for you, come up with a plan, and it will all be okay in the end.

Free USMLE Step 1 Questions

Preparation Time

  • Study during your first two years of medical school

Books Used

  • First Aid for the USMLE Step 1
  • BRS Anatomy
  • Haines Atlas
  • Neuroanatomy: Draw It to Know It
  • Thieme Pharmacology Test Prep
  • Pathoma
  • Pathologic Basis of Disease
  • Robbins Review of Pathology

Question Banks Used

  • UWorld
  • Kaplan
  • USMLE-Rx

Audio Lectures Used

  • Goljan for Pathology

NBMEs Used

  • All of them (Score range: 265-275)

272 on USMLE Step 1 (photo)

USMLE Step 1 Performance Profile (photo)

*This post has been used with permission.