Jane Joe- USMLE step 1-241

"The path from dream to success does exist, may you have the vision to find it, the courage to get onto it and the perseverance to follow it". - Kalpana Chawla.

This icing on the cake, a score of 241, tops an unforgettable year of ups and downs for me. It's not a high score and I admit I was a little disappointed with it. But it's my score and with the kind of year I had, it's acceptable.

I'm an Indian IMG, in my intern year of MBBS- the toughest year ever. I'm a student at one of the biggest hospitals in the country, with a patient load of thousands per day. So you can imagine that internship was extremely heavy. Earlier in 2019, I went for my 2 electives and also appeared for the CS exam (passed it). So my studies officially started from April 2019. At the beginning it was slow, I was getting acclimated to FA, which is not an easy book to read in the beginning. I supplemented it with videos such as BnB, DIT, Kaplan (Biochemistry is AMAZING thanks to Dr Turco). I would annotate only the important points in FA from the videos. I would get around 3-4 hours of study on good days, 6-7 on weekends and if I had emergency duty I would be working for 30 hours straight so those would be 2 days completed gone working. It was tough to stick to a deadline, but I still somehow managed to finish my first read by July (except pharmacology, which I regret not paying more attention and leaving to the last minute).

After July, I started on pretty heavy rotations such as general surgery and obstetrics and gynaecology. I also was pretty lost because I could not remember much of what I'd done, still felt weak in many aspects and realised that I had taken on a bigger load than anything I'd imagined. On the personal front my grandparents weren't keeping too well so that concern was always a nagging thought in my mind. I started UWorld, doing it on random timed mode. My average was around 60% at the beginning increasing to 70-75% at the end of it. But I still felt massively underconfident because there was A LOT in UWorld which wasn't there in FA and I suddenly realised it's like a whole other textbook to read. 3 months out, I took an NBME 21: 225. Felt like I was on the right path then.

I also supplemented FA reading with 100 cases of ethics by Conrad Fischer, 100 Anatomy concepts, histology from Di Fiore (because it was my weak spot), Kaplan for the table on substance abuse, pathology from Robbins ( a few concepts). Google and Wikipedia are a BIG help, especially for image based search of certain disease presentations. For Biostatistics I used UWorld Biostatistics Review, it was very helpful.

October rolled in and I took a leave from internship for around 2 months. I knew that my best study was going to happen now. I completed UWorld and one whole read of my annotated FA. At the beginning of December I took UWSA 1 and got a 234. That was a huge bummer but I realised that my anxiety had made me blank out and really mess up the whole test. The NBME 19 that I wrote later in the day was better relatively because I got 28 mistakes. Realised my mistakes were very fact based and I decided to start another read of FA. Weekly NBMEs:

NBME 24: 225 (3 weeks out)

NBME 23: 236 (2 weeks out )

UWSA 2: 245 (1 week out)- my story for this is hilarious. I'd just written UWSA 2 and got 245, felt amazing. Checked my mail immediately afterwards to see: EXAM CANCELLED from the Prometric. The exam centre had cancelled it and I had to take a new date. Originally after UWSA 2, I would have had 2 weeks and I was going to thoroughly read FA as well as search through UWorld questions and read my other resources. But now, I didn't have time for it, because my exam shifted to 6 DAYS EARLIER! I was in a panic! Couldn't write NBME 18 and started studying my material instead. The last week was intense: studying 13 hours a day with moments of severe anxiety.

The last 2 days before the exam I was exhausted and started ending my studies. The day before the exam I relaxed, went on a long walk, spoke to all my friends and slept early.

EXAM DAY:
Woke up after 7 hours of sleep, but felt like I had a headache so took an analgesic. Had toast and tea for breakfast and went to the exam centre for the 8 am exam. The Mumbai Prometric is great- comfortable and very smooth security and check in process. Got to choose my own booth and started with the exam.
I had started meditation earlier to curb my anxiety and it paid off, I was much calmer and relaxed. Took a small break after every block, would sip on coffee and eat some chocolates or a piece of a sandwich. Lunch was sprouts salad.

The blocks were mixed. Very UWSA like, I felt comfortable doing it. One new thing was questions which had images as answers so please work hard on your images. 2 blocks in the middle were bad, the rest were nice. Around the 6th block I felt like I was on autopilot but pushed on. Finally ended the exam and stepped out in sunshine.

The weeks after I rejoined my internship and got busy again. Met friends, enjoyed the NYE parties and basically focussed on every other aspect of life. I even appeared for NEET PG 2020.

On 15th Jan 2020, I knew the results would come out but the whole evening went in anxiety without the email. At 5 am on 16th January I opened my ECFMG account and found my report (I still haven't received the email). It was a mixed reaction of relief and disappointment, but I gradually accepted the score.

So for everyone struggling currently- have faith. It'll work out. Just keep swimming and you'll emerg on the other side as the winner. Don't let your NBMEs bring you down ( I've shed quite a few tears regarding these results). But remember, your score doesn't define you- you're still going to be a great doctor and you need to trust yourself through this gruelling process. Best of luck to everybody else and do your best!

Edit: Pathoma Chapters 1 and 2 right before the exam is GOLD. I'd done them earlier and written notes. But went through the videos 2 days before the exam.