USMLE Step 1-It's a PASS!

I've had a few requests for prep guidance for step 1 so I am going to lay down a detailed account in the hope that it may help someone else one day as well. I am a graduate of Rawalpindi Medical College, your achievements throughout med school are useless when you compete with the rest of the world, the earlier in med school you realise this the better it is for you and your future. If you remain as ignorant as I have been during that time, it will dawn upon you by the time of your graduation that they are giving you a rolled up empty piece of paper and calling out your name in front of a bunch of people most of whom are even more ignorant than you as far as the dynamics of medical education are concerned around the world in this day and age. If you have already graduated and reading this and starting prep for step 1 now, with no electives and research in med school, congratulations, like me you also have wasted the last 5 years of your time. I had never planned to take the USMLEs, and so I never bothered to focus my studies in the right path for Steps thinking that these exams are something that can only be attempted once you graduate out of the med school and you need all the knowledge of final year for them. I think an ideal time to start prep for step 1 is AS EARLY AS POSSIBLE preferably from the start of 3rd year summer vacations and you will be done before the end of fourth year prof. Another thing that I always blame was poor guidance, which is partly true, though there were not many people at RMC who could guide me since not many take the exam at RMC each year unlike some other colleges, I myself should take a larger part of the blame, because I was proud and did not ask for help from my seniors who did take the exam and were already planning a future in US, so my first piece of advice is to get advice from your seniors and ask them for help. Looking back on my med school career, it was actually riddled with mistakes, poor judgement, pride and ignorance. Cutting to the chase, I’ll go through the subjects in step-wise fashion. One thing that I get asked a lot is how much time to spend on each subject, here is the answer. IF you have time (which you should if you start our prep early), spend as much time as the subject demands, don’t follow other people , everyone has a different capacity to deal with various subjects, eg i can go through physiology quickly but anatomy takes time for me to learn, it may be the other way around for you. As far as the number of reads is concerned frankly speaking I did only 2 good reads and they almost took me 7-8 months, so instead of doing 4-5 hurried up ones I suggest you invest time in each subject and give them their due. Don’t rush the subjects.

Kaplan starts with histology, DON’T MEMORISE anything in that histology section, it’s way too long and most of the information is useless, the reason you shouldn’t spend time on histology is that Kaplan is way too detailed and it takes a very long time to memorize, for example the UW Q bank offers a total of 17 questions on Histology and histology part of Kaplan doesn’t help, it’s a complete waste of time, just watch the pictures and memorize and understand UW that is all for histology. Next move on to GENERAL ANATOMY, again don’t memorize everything in Kaplan instead give it one read and then move on to UW, so far as general anatomy is concerned I suggest you go with scenario based learning, because they are going to ask questions in that way, like for example, a person falls on his hand outstretched which nerve is more likely to get injured, things like that.

Next EMBRYOLOGY, the questions on the exam will test you on development rather than straight recall, for example kidney hypoplasia will lead to oligohydramnios or they may explain the Potter sequence partially and then ask you what will happen next, and what is different between secundum type vs primum type ASD etc. Finally NEUROANATOMY, the book that I recommend  for neuroanatomy is Kaplan Neuroanatomy. You have to go through it in the first read and it shouldn't take you a very long time. I used high yield neuroanatomy as well, it’s a fairly small book and has a lot of useful and useless details, it is amazing as far as pictures are concerned and will help you on the exam since half the questions are actually pictures of neuroanatomy, quick and easy to revise. But things you must know are tracts, brain stem and its associated vasculature (Circle of Willis), also think scenario based here like general anatomy. You can refer to the neuroanatomy videos on my channel, they'll make the pathways in CNS so much easier.

Next up PHYSIOLOGY, by far the most conceptually demanding subject of the lot. The book to use is Kaplan, I have never read BRS. The problem with physiology is the subtlety with which the information is thrown at you in the question stem. The subject seems easy, but is not, I suggest you spend a good amount of time understanding the graphs. UW is going to help there. Understand the various changes on the graph brought on by changes in preload, afterload, and contractility. In fact if you feel that your physiology is lacking I strongly recommend going through the Kaplan lectures if you can get your hands on them, but don’t go through all of them because they are really good and you will waste a lot of time if you get carried away, only go through the topics where you feel difficulty understanding , I suggest cardio, renal, and respiratory system ONLY since others are fairly easy to master. I cannot emphasize this enough, your main physio book is Kaplan and not FA.
GENETICS and MOLECULAR Biology are next. Use Kaplan and UW (read genetics and molecular sections of Kaplan first then move to UW) you have to keep in mind that these subjects are NOT TAUGHT at our institutions and you have to put in the time with them, it’s not about memorizing the steps of the various processes the questions don't ask that, rather the implications of the various aberrations in pathways and resulting symptomatology, they have a lot of associated diseases, and you must know them all. I think for genetics and molecular biology, the questions and explanations of Kaplan are better than UW, and resemble the real thing. BIOCHEM is next, the trick in Biochem is that like Anatomy it requires a little memorization but after that it’s more like Physio, think an easier version of physio, I wish I could tell you otherwise but you have to memorize in detail the pathways that are in UW, Kaplan has some additional pathways that are of no use. Some people suggest watching lectures of Biochem, again if you are having a difficult time with it, go watch them, I didn’t, since I was pretty confident about my Biochem. But here instead of going through the main book and then UW, go through them topic wise, like do one topic from Kaplan and then do it from UW that way you will save time, pay attention to the diseases, they are all important.

Next Up IMMUNOLOGY,  another one of those subjects that are completely and utterly neglected at RMC, and from what I believe has a major implication on how you understand pathogenesis and how and why the body reacts in the way it does to various pathogens. It’s a fairly easy subject, I recommend only Kaplan for it. Kaplan has some extra details and the questions at the end of the chapters can be misleading on how much detail is asked and what needs to be memorized, also the tables at the end of the immunology section have to be skipped, since they are useless and will waste a lot of time on memorization, just go with the CD markers one, that one is doable, and should be done, rest is crap, also do your best to memorize the figures of Immunology with cytokines like Biochem cause they are important and will help you memorize the functions of various cytokines. Moving on MICROBIOLOGY, stick to Levinson, your old school companion. However, don’t throw away Kaplan just yet; you need to read the chapter on bacterial genetics and viral genetics since both are very poorly explained in UW and are tested. Also the mnemonics for virology are much much better in Kaplan than in UW. Same goes for mycology and parasitology, Kaplan has way too much detail that will never be tested, so just go with UW save time here, you already have Levinson.

PATHOLOGY, first of all the book discussion, Pathoma or Kaplan, well if you are in medschool go with Pathoma. Believe me people have hyped up the main Goljan book but it's not as useful as people say it is, though Pathology is tested heavily on the exam it's not tested as deeply as presented in Goljan thus I would advise you to go with Pathoma. If you want to score good, you should concentrate really hard on this one, it’s not about knowing each and every detail of, instead it's more about correlating what you already know and how well you recognize them on exam. Also look at all the pictures in Pathoma, try and get your hands on an original one, and don’t skip on systems, I know people who skip on dermatology and then end up with a bad score, well each thing is tested so it’s better to cover everything from a small book than to skip stuff form a bigger one. SPEND TIME ON PATHO. So here is how you should approach Patho: listen to a lecture with the book in hand, although I didn’t because of time constraints, highlight and add info regarding the important points, you should cover Patho rapidly this way.

BEHAVIOURAL SCIENCES are to be dealt with in 3 sections, 1. Biostats, 2. Psychiatry 3. Ethics, this subject is very important and from what I believe is the main factor that could have gotten you from a 240 to a 250 plus in the past. 1. BIOSTATS: Biostats questions are in depth and it’s like one of those subjects that aren't taught elsewhere but the American medical graduates are very good at it, so it is expected that you know how to deal with them, it’s a fairly small component, please read it from both UW and Kaplan, and do all the questions at the back of each chapter, you may have to read it 3 times, this subject is tested to a fair extent and in depth, for example you must know just by looking at the p values and confidence intervals if a significance  exists or not, or if they are talking about sensitivity it’s probably a screening test, or or how to calculate standard error of the means. 2. ETHICS,  there is no sure shot way to guarantee yourself a good score in ethics, people use 100 cases by Conrad Fischer and other books I didn’t read it as "it's just common sense", just do questions again and again and you will get the idea. 3 PSYCHIATRY: very important, you need to be comfortable with various defense mechanisms, and psychiatric illnesses, how to differentiate between somatoform and malingering, do them from UW and Kaplan because it's important here to get exposed to scenarios, as much as possible.

Finally PHARMA, there is a reason you should cover this subject in the end, because not only does it require a certain degree of understanding and concept, you also need to have a solid ratta/memorization for a grasp on this subject, and since ratta is volatile the later you start it the better, I suggest going with Kaplan on this one, Kaplan is your main book here. I recommend that you don't watch the lectures during the first read, could do with finding some mnemonics online or making up your own, since at the end, you need a good memory here. The questions deal with both memory and concept.