HealthDecember 10, 2013

How this Firecracker scored a 270 on USMLE Step 1

Many Firecrackers have obliterated the USMLEs over the years and this isn’t the first 270+ score report we’ve received. Amazingly, it also isn’t the first time such high performing students have shared their stories (for example, if you haven’t read Trevor’s story on how he studied for USMLE Step 1 and scored a 266, click here).

It’s awesome to see that Firecrackers care so much about the success of their peers that they take time out of their busy schedules to share their experience with others. You guys are an inspiration to us all.

This is what this Firecracker said after he sent us his story: “I’m grateful for the opportunity to share with your users, hopefully it may be helpful.” Humility and brains! What a catch! ;) Without further ado, here you go!

–Firecracker :)

Hi there, fellow Firecrackers!

A while back, I shared my USMLE Step 1 score report with the Firecracker team to add to the collection of testimonials from individuals who found success incorporating its spaced-repetition platform into their study regimen. It’s my understanding that there were a few requests out there to hear more about my experience studying for the USMLE Step 1, and I’m happy to share my experience! I strongly believe everyone has their own set of unique circumstances and personality traits that contribute to their optimal study strategy. In the end, this experience should be about finding out how best to incorporate different study strategies and high-yield resources in a way that will work best for you.

Year 1

Some background information about me (at the risk of revealing too much): I went to a medical school that, at the time, provided a traditional medical school curriculum with significant self-guided learning. This meant I was able to spend a fair bit of time getting myself familiar with some of the resources I would later use during my dedicated study period. I’m also the type of person who’s able to gain quite a bit of information just from reading. To be quite honest, I did not spend a single hour in the classroom during the first two years beyond gross lectures and dissection. This may not be possible in all curricula, so be aware of this when considering the amount and depth of material I was able to cover on my own.

I started using Firecracker after hearing about it from some individuals in the class ahead of me, probably around the spring/early summer of my first year. At that time, I “flagged” all the topics that I had seen at that point in first year, and proceeded to review these topics over the summer.

Year 2

In the summer before my MS2 year, I had a fair bit of free time between an interdisciplinary course I was taking and minor research-interests. Therefore I took some time to go through an older copy of First Aid, and tried to reconcile the information that was most important for our subject exams and what was present there: jotting down notes in the margins where appropriate. Since my curriculum had covered the normal physiology, histology, and pharmacology of the major organ systems, the sections dealing with pathology seemed foreign to me. However, feeling ambitious (and with a year of pathology/pathophysiology ahead of me), I did the unthinkable: I studied ahead.

How did I do this, you might ask? Well, probably in simultaneously both the least and most efficient way possible. Each day I would read a chapter out of Robbins & Cotran Pathologic Basis of Disease (yes, Big Papa Robbins). Admittedly, I didn’t always retain this information. So, I purchased a year’s subscription to Pathoma (which I had heard from students ahead of me was invaluable during second-year studies anyway). After watching these videos alongside the text, I felt confident enough to bank the corresponding topics in Firecracker.

By the end of the summer, I had 100% of Firecracker’s topics flagged and continued to chip away at the daily reviews through second year. This was almost a job in itself: doing anywhere from 400-600 cards a day (probably like 4-5 hours worth of time). But I found I had plenty of time to dedicate to this task, as my studies for my subject exams were quite tolerable having seen the relevant material at least once prior.

After finishing my second-year coursework, I set aside a week to relax and create a thorough plan of study before I entered the dedicated study period for the USMLE Step 1. At this point I was already fairly familiar with the following resources:

First Aid: now filled with countless notes/annotations/scrap papers from years 1 and 2. I purchased a new copy and took off its binding. I then systematically sorted and transferred salient notes from my the previous copy, and made changes based on the errata posted on their website.

Pathoma: also annotated with notes/diagrams from the accompanying videos. Rather than transferring this content directly to the margins of First Aid, I opted to take off the binding of this book as well, and essentially transplant these pages into the appropriate “Pathology” sections of each organ system in First Aid.

Firecracker: At this point, the amount of questions in my daily review was still significant. I transferred some of the key information that I had been stumbling on in these reviews to my growing First Aid/Pathoma Monstrosity, and promised to continue working on this content throughout the dedicated study period (all the way up to the day of my test!).

I then obtained a subscription to USMLEWorld Step 1 Qbank (and Self-Assessments) and purchased the available NBME self-assessment exams. In hindsight, this seems like overkill. However, I remember quite clearly having conversations with others regarding my decision to not include certain resources (e.g. Goljan audio, Rapid Review Path, Kaplan, USMLERx). That’s not to say that I didn’t think these items would be helpful or were necessarily inferior to the resources I listed above. Rather, I had felt comfortable with a particular set of resources that had worked for me in my studies thus far, and felt confident that if I truly mastered their content I would do well on this exam.

Dedicated study period

Below I’ve attached a schedule that I created immediately before starting to study for Step 1. I’ve modified it a few times to share with others since my test, and I think it speaks for itself. However, as a general summary: my goal was to make three “passes” of First Aid (and associated content). Each “pass” would take less time than the previous, and each would end with me taking some kind of practice assessment. As you can see, I left one day (Sunday) each week free. This often wasn’t “free”, but rather was used for catching up on content that I either missed, or felt didn’t readily absorb during my studies of the previous week.

Calendar of a student's study schedule

My daily schedule would consist of the following.

7AM — Wake up, breakfast, shower

8AM — UWorld questions (46, timed, random)

9AM — UWorld questions (reviewed)

10AM —Daily topic (see calendar)

12PM —Break for Lunch

1PM — Daily topic (see calendar)

5PM — UWorld questions (46, timed, random)

6PM — UWorld questions (reviewed)

7PM — Dinner, relaxing, possibly reviewing the things that seemed challenging that day.

If looking at how I used UWorld (on timed mode, random organ systems and disciplines) made you raise your eyebrows… that’s completely understandable. Basically my consideration was this: it would be unrealistically easy to use UWorld untimed or in tutor-mode. Further, by taking the questions on the topics I had just studied on a given day, I thought that would unfairly skew my performance. Also, you’ll note that I didn’t give myself much time to review the results of each set of questions. While unfortunately this meant that I may not have gathered every single educational detail provided by the creators of USMLEWorld, I still was able to learn quite a bit from this resource (particularly my mistakes). By doing two blocks of questions per day I was able to get through all the questions initially, through my “marked questions” a second time around, and incorrect questions at least once.

My progress

As mentioned previously, I had purchased access to the NBME self-assessment exams as well as the self-assessments offered by USMLEWorld. As I progressed through my study schedule, I was sure to record my performance on these tools, and their corresponding predicted USMLE Step 1 score. This information is provided below.

Graph of NBME and USMLE self-assessment scores

Test day tips including “whiteboard topics”

Finally, I’d like to leave you with a few tips/suggestions that I have regarding my experience on D-Day. It can be a nerve-racking situation and undoubtedly these are some things I would have liked to have known before stepping foot into the testing center:

  • Make a trip to the test center on a weekday (or weekend, depending on when you take your test) at around the same time that you would otherwise need to in order to arrive on time for the day of your test.
  • Go shopping for snack food/drinks/candy (more on that in a bit).
  • Get gas, check your tires, oil etc.
  • Arrange for someone to be your “emergency contact person”. That is, someone that is willing to be there in case your car doesn’t start, you forget something, etc.
  • Make sure you have your testing permit printed out and ready to go (from the NBME website—where you registered).
  • Set aside your clothes/keys/etc. for the next day.
  • Wake up really early, eat breakfast and let it settle.
  • Wear comfortable clothing. Multiple layers would be ideal. Consider sweatpants.
  • When you check in, you will get a set of keys to locker to store your valuables. Possible things to put in your locker (at least what I chose after long thought):
    • Cell phone (silent/off)
    • Notes (not really something I flipped through but I felt more secure knowing it was there)
    • Your OTC pain-reliever of choice (chances are you’ll be getting a headache later).
    • Granola bars
    • Energy drinks
    • Tea
    • Water
  • Get everything out of your pockets—you’ll need to be showing that they’re empty.
  • Ask questions now. For example, I didn’t use ear-buds, but it wouldn’t hurt to ask the day of (I think I’ve heard that you can, but this may be variable based on location/supervisor/etc).
  • Take the sheet of scratch paper (laminated grid paper) and felt-tip pen
  • You’ll be asked to copy down a number to be used to log into the test and record it on the paper. Try to do this legibly, as it will be needed throughout the day.
  • Take a moment to figure out the testing station. Decide whether to use the noise-canceling headset or the headphones. I chose the headphones simply because I didn’t want to mess around with changing in the middle of a test in case there was an auscultation heart sound question.
  • Log in and start the tutorial. While the tutorial is ticking, take a moment to jot down any last-minute details you’re afraid are going to fall out of your head. This is fine, as long as your fairly quick and don’t look suspicious (which is why I recommend doing it while the tutorial is ticking). Consider what things will go on this list beforehand (see my version below).
  • Take a couple of deep breaths and try to relax.
  • Start the exam.

The interface is exactly the same as UWorld. The only exception (I think, but my memory is fuzzy) is that the laboratory reference values may appear slightly different. Unlike Uworld, you can also highlight parts of text.

If you find that you’re getting well ahead of yourself with regards to time, try closing your eyes and taking a 5 second break.

Even if you did this for all 46 questions that’s only 4 minutes.

Consider how you’re going to use your break time. For example, this is what I did:

Block 1, Block 2: 10-minute break

Block 3, Block 4: 10-minute break

Block 5: 10-minute break

Block 6: 10-minute break

Block 7: Finish!

A student's exam-day scratch paper topics

Final thoughts

I won’t sugarcoat it. The USMLE Step 1 is a challenging exam. The amount of material that’s fair game seems overwhelming. At the same time, it’s all too easy to get caught up worrying about the implications it might have on your future (real or imagined). The best advice I can offer is to approach it just as you would any other test. That means building good study habits early on, staying organized, and to never give up. Luckily, if you’ve gotten this far, that means you’ve already had plenty of experience doing just that. And don’t forget, there’s an abundance of resources out there to help you succeed. All you need to do is integrate those that will work best for you!


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