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Esli Medina Morales Step 1 Experience----Score: 251



Score: 251
Test date: 27 Sept, 2017.
Length of study: 18 months à 7 months (+ working + research) + 11 focused. Background: • Peruvian Physician, upper 1/3 of class. • YOG: 2016. Study Hours: • Initial 6 hours Chronometer for 6 months à Up to 7 hours chronometer 7 months prior, and then up to 9 Hours chronometer lasts 2 months • Schedule: Monday to Sunday with 1 evening off. Material used: • Based on disciplines according NBME distribution o Behavioral Sciences: Kaplan LN 2015 + Kaplan Videos 2015 + BRS behavioral + Conrad Fisher 100 Ethical Cases o Biochemistry: Kaplan LN 2015 + Kaplan Videos 2015(Dr. Turco 2014). o Genetics: Kaplan LN 2015 + Kaplan Videos (Dr. Turco 2014) + Kaplan Qbank (lasts weeks, up to 65 q). o Gross Anatomy: Kaplan LN 2015 + Kaplan Videos 2015 o Histology-Cell Biology: Kaplan LN 2015 + Kaplan Videos 2015. o Microbiology and Immunology: Kaplan LN 2015 + Kaplan Videos 2010 (Dr. Moscatello). o Pathology: Pathoma (book + videos) + Goljan (book à focused on Blue lines, Charts, Diagrams). o Pharmacology: Kaplan LN 2015 + Kaplan Videos 2015 o Physiology: Kaplan LN 2015 + Kaplan Videos 2015 + BRS physiology. o Biostats: Kaplan LN 2015 + Kaplan Videos 2015 • Review Books: FA step 1 2016. QBanks: • USMLE Rx Q Bank: During first period, aprox 700q-900q. • USMLE Kaplan QBank: During first period, aprox 400-500q. Then last for Genetics and Biochemistry. • USMLE world Q bank: During second and Third period. 2 times online: 2500 q x2.

FlashCards • Anki (2500-3000 cards) o Made by myself. For each Uworld and NBME concept that I’ve got it wrong or didn’t have a clear picture, I make a respective card. o Only works if you do it EVERY DAY. Learning process is according spacerepetition pathway. My Notes: I make notes in separated papers and added to the FA at the end of my learning process. How to approach the STEP 1? • Be honest with you. First know where you are, and then plan in advance. • There are many strategies for approaching this exam, and according your desired score, each strategy is different. • This approach works it better for those coming from HISPANIC/LATINAMERICAN countries. Medicine is pretty much taught in a similar way across all Latin-America and similar with other Mediterranean European Countries. People go straight from high-school to Med School, which usually last for 6-7 years. This is very DIFFERENT, from the US, where BEFORE going to med school, people are trained in SCIENCE BACHELOR. This provide a huge advantage in terms of basic science knowledge. • 1st PASS: ALL APPROACH vs SUBJECT-WISE APPROACH o ALL APPROACH: You can start from reading all the kaplan, BRS, pathoma, and pathology books. Then go towards Uworld and FA. I do not recommend this. The next approach it takes longer time but it is more helpful in terms of mental organization. o SUBJECT-WISE APPROACH § Start with 1 topic, and then, for each section that you find in the books, read the same section in F.A, and add additional pages of relevant information • E.g. Starting CVS physiology on Kaplan (Curves), then go straight to CVS physiology FA books and try to integrate what you learn from once source into the FA • Why this? FA is gone be YOUR FINAL INFORMATION SOURCE at the end. § Once a topic is finished (e.g. ending with physiology), before moving to other topic, do all the UWORLD Q that are pertinent to that topic in a SUBJECT-WISE UNTIMED MOOD.
Here is not relevant to test you but instead to LEARN ABOUT IT. UWORLD is a learning tool. • Take note of everything (specially the Educational Bottom line) in FA following the pertinent topic/subject. § Do this approach for each subject/topic. • 2ND PASS: UWORLD RANDOM TIMED MODE and FA o BEFORE STARTING do your FIRST NBME § ONLINE. Why? B/C is the only way to know where is your buildup knowledge after the first period. o Start from 1 or 2 blocks of UWORLD each day. Plan an NBME every 2- 3weeks. o Read every note, and every word of FA. Each sentence/word is there for something (tested on the read deal, or past NBME). Finish 2-read of all FA. • 3rd PASS: NBME and FA o Here you are preparing your ENDURANCE FOR THE EXAM. § Practice 1 NBME online + 1 NBME Offline or 2 UWSA for simulating 8h exam. At least try this 2 or 3 times. o Continue reading FA and focus on your WEAKS AREA according your NBME’s feedback. o Consider additional Qbanks (Kaplan, USMLE Rx) in those areas that you are weak o What can make you score really high is being STRONG in EACH TOPIC. On the real deal, if you are not comfortable in a particular topic, you will probably get wrong questions due the high-stress environment. o It is not just about knowledge, but EMOTIONAL management and TestTaking skills. This can be coped by practicing NBMEs as you were like in the real deal. Self-Assessment • NBME 15 online (April 2017): 217 • NBME 2 offline (May 2017): 36 wrongs/200q • NBME 5 offline (June 2017): 30 wrongs/200q • NBME 12 offline (July 2017): 25 wrongs/200q • NBME 16 online (03 Sept 2017): 230 • NBME 11 offline (06 Sept 2017): 18 wrongs/200q • UWSA 1 online (10 Sept 2017): 261
• UWSA 2 online (13 Sept. 2017): 242 • NBME 17 online (9 days’ prior exam): 244 • NBME 13 offline (10 days’ prior exam): 21 wrongs/200q • NBME 18 online (5 days’ prior exam): 242 • NBME 19 online (2 days prior exam): 252 * REAL DEAL: 251. Approach for each subject (From + relevant to less) 1. PATHOLOGY a. 30-50 % tested on the real deal. You should have a clear picture of every disease, from the molecular part to the pathogenesis of the disease i. Started with Pathoma (book + videos) --> Great introduction of every aspects of pathology, specially in terms of histopathology and the relevant findings of each disease. ii. Ending with Goljan --> GOLD. This book provides with everything and its the real deal for INTEGRATION of all basic science towards pathology. This is the book for understand PHYSIOPATHOLOGY, whereas Pathoma is just a Pathology book. I read all chapters, focusing mainly in the summary lines (blue lines), tables and figures. I consider you can skip Pathoma, and go just straight towards this book. I consider this is one of the main reason that make me score > 250. iii. Then go to UWORLD and FA. 2. PHYSIOLOGY a. Correspond on 10-15 % of the test, and it is integrated with each part of the test, specially with pathology. i. Started with Kaplan LN 2015 and Videos. Consider that the book is just ok. The good damn thing here are the VIDEOS, specially those from the online classroom. Very important is your basic science is weak in terms of physiology. ii. Finishing with BRS. Not for something, this is categorized as A+ by FA choice’s readers. This book is aprox. 300 pages on length, but it really makes it worse. There are a lot of concepts that are not teaching somewhere else i.e. FRC graphic on FA (from Resp.) can be explained by this book. Also, each chapter has around 30- 35 Q that will test your learning process. GOLD for renal, CV and Resp.
iii. Then go to UWORLD and FA 3. MICROBIOLOGY a. Correspond around 10% of the test. i. Started with Kaplan LN 2015. I don’t consider this book necessary for this topic. Videos are also not that useful ii. Just stay with FA and UWOLD. Everything tested in each NBME and UWSA is in this 2 resources. This is a very easy topic if you provide the time for memorizing and understanding the whole picture of microbiology. Once you mastered it, you are done! 4. IMMUNOLOGY a. Correspond around 5% of the test. i. Started with Kaplan LN 2015 and Moscatello old videos 2010. This is probably one of the most though topic that you can have on the real deal. The approach for asking a question can be so vague, that you really need to understand all the picture to have the answers. Moscatello from Kaplan provide a strong basic knowledge of basic concepts. After this go to UWORLD and FA. 5. PHARMACOLOGY a. Correspond around 10% of the test i. Started with Kaplan LN 2015 and Videos. This topic can be really though, specially in terms of AUTONOMICs and how reacts to the different drugs (i.e. EPI vs NORE in terms of heart rate, SBP, DBP, bradycardia reflex). Kaplan Videos are absolutely needed. HY stuff: First 2 chapters of Kaplan: Pharmacodynamics, Pharmacokinetics, ... ii. After this go to UWOLD and FA. 6. BIOCHEMISTRY a. Correspond around 7% of the test. i. Started with Kaplan LN 2015 and TURCO videos from Kaplan. This is probably my though topic. Biochemistry is not something that need to be memorized, by instead, to be really understood. Each part of biochemistry SHOULD BE INTEGRATED with each other topic. Usually the Q are not straightforward, but are Integrated in the other topics. TURCO is the best in teaching how to learn this ii. After this go to UWORLD and FA 7. GENETICS a. Correspond around 3% of the test i. Started with Kaplan LN 2015 and TURCO videos. This topic can be really hard at the beginning, but after being exposed to the concepts and multiple questions, you are more likely to be comfortable in the real deal. ii. After this go to UWORLD and FA. Uworld provides with great understanding of FA concepts that are not well explained. CONSIDER to use KAPLAN QBANK. Uworld questions are approx. 40-60Q. In case you have problems, Kaplan have around 45-60 more questions that will enhance your performance. This is one of the topics that I consider Uworld doesn’t cover completely at all. 8. HISTOLOGY and CELL BIOLOGY a. This topic can be covered by PATH and BIOCH. Almost all the questions are found in those respective topics/books. 9. GROSS ANATOMY a. Started with Kaplan 2015 and Videos. I consider this NOT NECESSARY due the fact that FA and UWORLD can cover this topic. In the real deal, even after being full prepared for everything, this topic was the harder (never seen questions neither topics) and my lowest performance subject on the real deal. 10. BEHAVIORAL SCIENCE a. Started with Kaplan 2015 and Videos This is for sure NOT NECCESARY. Go down! b. BRS Behavioral. This book is GOLD!. Cover from psych to behavioral disorder including some Biostats. Every chapter is relevant and provide with lot of MCQs that will test your learning process. c. Go then for 100 Cases of CONRAD FISHER. This book made me cross the 250s. Behavioral was my weak, and specially the ethics section. It takes 4-8h for reading it, specially the cases. Do it at the end-stage when starting the NBME. Can really make a different once scores are going beyond the 250s. d. Uworld and FA as always. UWorld is GOLD for Psy. 11. BIOSTATS a. Started with Kaplan 2015 and Videos This is for sure NOT NECCESARY. Go down! b. Focus on Uworld and FA. More than enough  Test Day • Whatever you do, INSOMNIA OR SLEEP PROBLEMS can be present. o I didn’t sleep at all. Never experienced that before in life, neither any NBME/UWSA. o Regardless of what happen immediately or during the test, the Stress and your prior built confidence are gone help you to manage this situation. o Prepare your breaks before the test. I use 5, 5, 10, 15, 5,10, 10. I decided to recover myself after each block to avoid being burn-out. o The Test is a mixed between NBME and UWORLD. IF you are doubting b/w 2 options, follow your gut feeling and move forward. o At the end, once you are done, your life, as before this journey started, is coming back.


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