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r/step1
inamedmycatgarbage • 1y !

261 Writeup (Did not really use Zanki or First Aid, 224 Amboss Baseline)

Hey everyone, thought I'd do a writeup because there really weren't many people that posted these
with a similar pattern of scores as mine (felt that most 260s started off near that range) and it was
really helpful when someone did. As a disclaimer, I think this is a good approach if you are very
confident in your standardized testing ability- different methods work for different people, and this
is just what worked for me.
TL;DR Focused on school/in-house through the year with Boards and Beyond to supplement,
Uworld was my Bible in dedicated, practice test scores started at average and generally
trended up.

I'll start with the practice tests before going into my background because personally when I read
these I just scrolled to that part anyways to see if the person had a comparable situation first.
Original goal was 240, revised to 250 at the time of the test.
Practice Tests
Took NBME 13 and 16 offline prior to 3-digit baselines and before starting/finishing my last module
of school and got ~70-75% which I think equates to low 200s but idk for sure.
Amboss: 224 (2/23)

School CBSE: 230 (2/24)

UWSA1: 239 (3/8)
NBME 24: 228 (3/16)
NBME 23: 228 (3/23) - Moved my original April 16 exam to June 26 about a week after this

Completed Uworld First pass: 73% (4/9)

NBME 17: 244 (4/10)
NBME 15: 250 (4/20)
NBME 19: 225 (5/6) - curve is harsh, was going through some personal stuff, and I hadn't done
much more than a little bit of Amboss in about a month due to covid delays so this didn't bother me
too badly
:
 NBME 21: 248 (5/16)

NBME 20: 250 (5/20)Share this

- after this oneLink x
I decided I was going to take NBME 18 instead of 22 to
determine if I wanted to move my exam up because i was sick of covid delays (had been cancelled
3 times) and I felt I was plateauing. Plus I just wasn't getting much out of my 2nd pass of Uworld.
NBME 18: 252 (5/23) - decided to move my test up by a week after this
SHARE LINK
Free 120: 88% (5/27)

UWSA2: 260 (5/30)

Reddit score predictor: 250.5-252.5 (date adjusted). 239-262 (95% CI)
USMLE Step 1: 261 (6/2)
Okay so in case you want more info, I'll go into my background, process, and resources I used.
Background and Medical School

Below average GPA in undergrad (for a med school applicant at least), but have always been good
at standardized tests and my MCAT (517) was probably the only reason I got in at all.
I go to a US MD ~mid tier school, and I've actually done a lot better in my med school classes than I
ever did in undergrad. Step after 2nd year, originally 5 week dedicated that became 12 because of
covid.

Did not really worry about Step much until 2nd year, and even then I focused mostly on classes and
supplemented with Boards And Beyond + Rx to practice for school exams.
Resources

Gonna list these somewhat in the order that I encountered them. First Aid was nothing more than a
paper weight for me, which I should have foreseen because I hate textbooks.

Class Material: My classmates probably think I'm crazy for this, but I mainly learned from lectures
(at 2.5-3x speed) and slides.

Boards and Beyond + Pathoma + Sketchy Micro: Great supplement for me during the school year
to rephrase topics that weren't covered well in class.
Zanki (Organ Modules): Briefly tried this and found it not effective for me in the slightest.

USMLE Rx: Didn't think the questions were very good, but the topic filter system is top of the line
and a great way to study for your school exams. Didn't get close to finishing or touch it in dedicated
though.

UWorld: I did a few blocks to practice for school exams early in my 2nd year but then realized it
would be better to save this for dedicated. For dedicated, Uworld was the core of my studying. I
used it as a primary resource for a lot of my "content review", and made anki cards out of not only
my incorrects but also any answer choice or part of the explanation that I was unfamiliar with. I
started a 2nd pass too but honestly the efficiency drops big time there so I didn't even get halfway
through.
Pixorize: Best way to learn biochem, wish I found it in the beginning of med school. Short anki
:
 decks found online helped for this.
Zanki (Pharm): So this I decided to try after I had gotten through most of UWorld when my exam
got delayed from mid April to late June because I just had so much time. I actually got through 2/3
of the new cards but didn't mature very much of it. I think this was helpful but ultimately not really
necessary, honestly can't think of a question I only got correct because of it.

Amboss: Did a 5 day trial + 2 week code and got through about 600 questions, averaged 78%.
Nice for keeping your brain sharp after finishing Uworld but I don't think I saw any concepts on the
real test that I didn't see on Uworld + NBMEs.
NBMEs: I highly, highly recommend finding a group of about 3 people to review each test with - it'll
help you find your blind spots. It helps to google the curves for these, kept me from getting
discouraged when my scores didn't improve or dropped.
Dedicated + Covid-19

So I had originally planned to do a 5 week dedicated and take the test mid April. I had a pretty
standard dedicated at first so I won't go into too much detail, just gonna re-emphasize that I spent
the vast majority of my time on Uworld and minimal time doing "content review." Review of
concepts you didn't know in Uworld + NBMEs (even those you got correct or were answer choices
you didn't recognize) is a must in my opinion- whether with anki or some other way is up to you.
Spent about 45 minutes a night reviewing those cards.
Covid obviously made things very stressful, and in the latter half I was studying between Zoom
classes. That said, it was helped a lot by the fact that I did the bulk of my hard studying before
those classes began so I was mostly maintaining at that point.
Do not be afraid to move your exam up- I think by doing this I took my test at my absolute peak and
it paid off.
The Real Deal

Like everyone else says, it's hard. The questions are longer, the answer choices are vaguer, but
everything is better written than the NBMEs and more like UWSA2 and the Free 120. I didn't feel
good after I took it. I didn't think I did terribly but I was mentally preparing myself to get 10-15
points below my predicted.
Final Thoughts

Like everyone else will tell you, Step 1 is ultimately just another standardized test and it should not
define you as a person. I really believe that you don't need to memorize First Aid cover to cover or
mature all of Zanki to do well . You just need to know enough that you can adapt to each question
and extrapolate to the answer.
I know this is somewhat ~controversial~ to say on this subreddit, but I'm glad this exam is going to
be pass/fail (in the future when everyone is prepared for it to be). I don't feel that I made some
tremendous breakthrough in my medical knowledge between the time I was scoring in the 220s and
when I got my 261. I simply got better at taking this test. All of that said, I was shocked (in a good
way) to see my score, and I am incredibly thankful for it and humbled by this whole process. I hope
this writeup helped you, and feel free to ask me whatever you want and I'll try to answer.
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 71 Award 21

21 Comments sorted by Top ˇ

Post is archived

HowellJolly973 1y !
Thanks so much for sharing this honest description of your studying and how you did at the
beginning. Definitely gives those of us who aren't scoring what we want to initially in our
NBMEs some hope. Congrats on a great score!

5 Reply

DumbFuckMD 1y !
We have similar stats, I’d die if I got the upper end of my CI like you. congrats!

3 Reply

futuremed20 1y !
First of big congratulations!! Anything you feel like you did in the last couple of weeks to
bump up your score? Rapid review of first aid? Also did you do any questions in the couple of
days before your exam?

3 Reply

inamedmycatgarbage " 1y !
Thank you! So I actually didn't even bring First Aid home with me for dedicated, but I tried
a couple rapid review anki decks and they honestly just stressed me out because I didn't
really know what each card wanted from me until I saw it, so that kind of made it take
forever so I gave up on that pretty quickly.
In the final week I reread pathoma chapters 1-3 and it legit got me multiple questions on
the test so I would say definitely do that. Also I rewatched some high yield sketchy micros
(invasive fungi especially) and pixorize biochem pathways and that also made a tangible
difference with some questions on the exam. Otherwise, I mostly kept it business as usual
with doing my Incorrect Deck reviews.
In terms of the last couple days, I did 2 Uworld blocks (2nd pass) 2 days before the test,
but I didn't do anything on the last day before the test other than the last of my Incorrect
Deck reviews early that morning. Basically didn't even think about Step 1 material
(although I certainly couldn't help thinking about the exam itself) in the 24 hours leading
up to the test, and I really recommend doing that (but maybe try it out with NBME 18 or
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 UWSA2 first) because I felt really fresh and ready when I sat down for the real thing. I've
heard that if you study too close to the exam you bias yourself to certain answer choices,
so I really didn't want to do that and I'm happy I didn't.

2 Reply

[deleted] 1y !
Excellent work. The part about not feeling any smarter between 220-261 really resonates as I
round out my dedicated.

Any tips on maintaining your peak level while managing school zoom sessions? I'm starting
the same thing with clerkships next week and haven't hashed out a plan to stay sharp yet.

3 Reply

inamedmycatgarbage " 1y !
I'm glad that resonated!

I think it definitely depends on how heavy/light your schedule will be, but I'll just give you
mine and hopefully it's applicable. I had 3 hour days of class twice a week and 1.5 hour
days of class twice a week. Had a decent amount of homework to do, but nothing crazy
and the stakes were fairly low.

I generally did a block in the morning before class (Amboss during my free trials and
Uworld after), and then reviewed them in the afternoons when my classes were over. At
that stage my review went pretty fast, and when I was just doing 2nd pass Uworld blocks I
was usually able to get in another block or 2 in the afternoon. Basically I'd use my zoom
sessions and homework as "breaks," as depressing as that is to think about lol. I think it
really comes down to accepting that once you've finished the bulk of your studying, there
isn't a whole lot left to be gained from content review. so you just need to focus on keeping
your brain in question answering mode.

3 Reply

[deleted] 1y !
Awesome, thank you for sharing this. I love a good 40Q "break" to take a load off!

1 Reply

inamedmycatgarbage " 1y !
hahaha actually meant the zoom sessions are your break but regardless, ya it really
sucks. Best of luck, you can do it!

2 Reply

Malik-Faesal 1y !
:
 Congratulations What are the best resources for biochem and What videos go well with FA ?

3 Reply

inamedmycatgarbage " 1y !
Thank you! Pixorize for biochem 100%. I watched all of the pathway videos and did
Rabaska's deck for those. Made those types of questions really simple. Also very
important to do the videos for the hereditary disorders.
I have no idea which videos go well with FA because I never really looked at FA, but other
than the standard Boards and Beyond + Pathoma, I'd recommend checking out the Dirty
USMLE videos, especially the ones about familial dyslipidemias.

5 Reply

the_struggles_real 1y !
First of all congrats!!! Absolutely insane score and I'm happy to see someone score in the
positive extreme of their CI :)

Second:

I don't feel that I made some tremendous breakthrough in my medical knowledge

between the time I was scoring in the 220s and when I got my 261. I simply got better
at taking this test.

I really appreciate you saying this because I feel as though many of us don't realize this.
Granted I have not scored in the 260's but as someone who's lingering anywhere from 232-
low 250's, I never felt as though there was a particular reason that made me jump in terms of
knowledge. I'm sure I'll know more once I take my exam but it seems like the gap between a
230+ and 250+ essentially comes down to;

1.) not missing any of the "gimmie" questions (i.e. Pharm MOA/AE, Micro, biochemical
pathway)

2.) keeping yourself from freaking when you see something completely foreign and doing
your best to perform a differential based on shit you already know. Knowing we have to be
able to both read/answer the question in something like 1.4 minutes or something therefore
keeping in the mind that they're asking something that an M2 should be able to answer
(except for those WTF/EXPERIMENT/LOLKBYE questions, fuck them for that anxiety inducing
shit)

3 Reply

inamedmycatgarbage " 1y !
Thank you! And yes I think you have it exactly right. The main gains there are just
memorizing a collection of facts of which there are many but that you can certainly learn
within a dedicated period, and just feeling confident with the exam by being certain that
:
 the information to get the question right is on the screen in front of you and you just need
to find it.

The other big thing I would just add is knowing what the most common answers for certain
types of questions are, which you can only know by doing all of Uworld and several
NBMEs. There were definitely a few toss up questions on the real deal where I couldn't be
certain about an answer but I chose it because it was just a way more common diagnosis
(or perhaps not even that, just a more commonly tested concept). I think those toss ups
must have been why I felt kind of shitty about the test but did well anyways.

4 Reply

Malik-Faesal 1y !
Thankyou so much

2 Reply

waterbug123 1y !
I am glad I read this. I wasn't sure if focusing on content in classes was right even though I
feel that I know more and am learning. I kept on reading do practice questions for everything
which didn't make sense to me if you don't know the material. We have a very similar
studying style at least for classes. How did you learn pharm for in class exams?
Congratulations on your score!

2 Reply

inamedmycatgarbage " 1y !
Thank you! And yes definitely, ultimately the information really is the same, it's just how
you put it in your head and if class is the best way for you to do that you should keep doing
it and trust that Uworld will show you when you need to learn something. In terms of
practice questions for everything, I will say that it's really important to use practice
questions and especially make it your focus in dedicated, but ya if you're not getting
anything out of it during the school year then you're right to save it for when you have
learned the material.

To be honest I'm trying to think back to my in class exams and I didn't really have a method
for learning pharm, I pretty much just did the same I did with any fact I needed to
memorize for class where I had a process of watching lecture and taking notes -> hand
writing key terms (including pharm) for repetition -> synthesizing everything I knew as
answered objectives in a study guide. Honestly our in class exams really didn't cover that
much pharm and it was the area I had to do the most catch-up on in dedicated.

1 Reply

diamondblackfan8 1y !
:
 Amazing. Could u tell me if doing pixorize biochem pathways was worth it?. I absolutely loved
it for immuno due to my lack of basics in it. However I did leave out a few things I was
comfortable w. I was planning on just doing storage disorders+biochem from pixorize.
Opinion?

2 Reply

inamedmycatgarbage " 1y !
Yes it was really worth it. Not 100% necessary but I gained a level of confidence with those
types of pathway questions that I never had before. Like for example I had previously
memorized the biochemical cause of cystinuria, but after watching that pixorize video I felt
like I could teach it. So in terms of volume of questions it wasn't a crazy amount but in
terms of giving me confidence during the exam it was a big bump, if that makes sense.
I personally just did vitamins, biochem pathways, most of the storage disorders (but I
didn't bother with the ones that I literally never saw a question on), and some of the
genetic/chromosomal disorders because I kept finding I'd get those wrong. All of it was
helpful for me!

1 Reply

diamondblackfan8 1y !
Hey thanks so much for the detailed answer! And congratulations!

2 Reply

directheated 1y !
For NBME content review were you using the site that has answer explanations or something
else? Thanks and congrats on that score!

2 Reply

inamedmycatgarbage " 1y !
I used that site but also sometimes I would just google something like "NBME 18 answers
and explanations" and find that someone had put together a pdf of everything. Also that
was where reviewing with friends really helped, usually we could get to a consensus when
we weren't sure of an explanation.

2 Reply

SqueakyArchie 285d !
Little late. Hope you respond to this. I am about to finish my first year and recently started
preparing for step. I am doing Biochem as of now. I have done about half of it from BnB
videos and simultaneously doing the Anking deck. So far this is going great for me . now is
there any benefit in trying out Pixorize ? Will it provide me an extra edge compared to BnB.
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 Coz if the sole reason to do pixorize is to memorize , I think I am fine on that front as Anking
surely helps.

1 Reply

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