My USMLE Step 1 experience as a student.

Assalam-o-Alaikum. I am final year medical student form Pakistan. So to start my whole journey.. It was end of my 3rd year when i started thinking about taking USMLE Step 1 , as that time the main reason was that i was doing reasonably well in my exams with very less effort  so to take extra challenge 😛 i thought of doing some thing a bit crazy, as i heard its a difficult exam. So to get started i starting collecting information essentially from some forums notably where i read a lot of exam experiences and recommendations of people who have already taken the exam at that time. 3rd year went like it and i passed it. Then came the 4th year.. So to get started i bought Kaplan Step 1 Books, Goljan Pathology 3rd ed, Pathoma pathology.

To start with i started with Kaplan Biochemistry videos with book.. As i have to go to college so i used to read/watch videos of one or two chapters everyday and ended biochem with this lazy routine in one month. The thing i was focused on was to understand the topics rather than to rattalize it. Next came Physiology again Kaplan videos and book with above routine and took me a month again. Kaplan videos were more of a waste of time especially where Conrad Fischer teaches and wastes immense amount of time. I would recommend to not watch videos or even if u have to watch see those topics which you cannot understand by reading book. Next came microbiology, most irritating subject for me, it needs a lot of memorization.. Again kaplan book with videos. Please don’t watch micro videos its complete waste of time, the teacher is just reading the book so its better you read the book yourself 😛  Then i started pharmacology, i must say you SHOULD watch its videos especially where Dr. Raymond teaches.. he is one of the best teacher i have ever seen!! Making difficult topics easy is his specific quality. Then came the big giant Pathology.. Apart from step 1 this subject was more important as it was in 3rd professional exam so i have to take both things together. I started with Goljan and watched Pathoma Pathology videos along with it chapter wise. So to say now “GOLJOMA” I probably read it 3-4 times with videos as sometime i have to prepare for class tests so used GOLJOMA every single time.. Time passed very quickly and it was nearly the end of 4th year and i was in the middle of no where.. So to take my preparation to serious perspective i starting doing USMLE WORLD and bought FIRST AID BOOK(THE BIBLE). I was able to do Pathology, Pharma, Micro form UWORLD at that time and annotated everything on my FIRST AID (starting using FIRST AID early is always better.. no doubt) and time went very fast and i took 3rd professional exam and was officially in final year 🙂

As you know final year is always full of lectures of medicine, gyne.obs, peads and surgery and our college made us a favor by starting 6 lectures from first day 😛 and was i like ok what to do now 😦 So started UW again and started biochem and then anatomy and then physio.. Yeah in exact opposite order in which i should be LOL. At this time i had no idea of Immunology and Behavior science and biostat.. So to start these subjects i watched kaplan immunology videos and just understood the thing!! Please don’t read the immunology from kaplan it will make you confused than focused.. later i read FA and did UWORLD annotation. Biostat/BS was a complete new subject for us because its not taught in curriculum in that way usmle requires. Watched Kaplan videos and Book. This book and videos are my favorite from kaplan. You cannot skip that its a MUST watch!!! and then UW for these subjects. Finally i was done with my first read 😀

At start of March i registered for the exam and took triad of August on wards as summer vacation would be there and i would be able to take some breaks.

Now i started focusing on FA only.. reading it and understanding the book. It was my second read of FA but still i was having some kind of memory problem and i was still forgetting the things and every time i read it i tend to forget it so i made habit of focusing more on the concepts rather than pure “rattalization” and went so till May..

At the start of May i got a unusual LONG break form college and this was my first college vacation so to say for final year.. This was my real 3 month break for step 1 exam.. This was when i started taking the whole thing seriously LOL and i knew the exam is now coming. So to utilize this precious time 😛 FA again and again till it went to deep layers of cortex and got to spinal level !!

2 months before i took UWSA1 and got 240s and i was hugely disappointed with myself as i know i hugely over predicts. Repeated some weak areas form first aid and took NBME 11 and got score in 220s. Online UWORLD again for one month and got 82%. 2 Weeks before exam i took NBME16 and got 234 and 5 days before exam 237 on NBME 15. A week before I did Netter Atlas for Anatomy just looking at pics, Conrad Fischer 100 Ethics Cases and UWORLD Biostat. I could not extend the exam date anymore than 21 August due to many issues !! And just took exam on 21 Aug.

I was lucky to get the appointment for exam because all appointments were cancelled because of the political situation in the city even yesterday appointments were cancelled!! Anyways I had enough sleep last night.. 5 hours although i was unable to sleep and woke up at mid night..

Exam Experience: Reached Islamabad Prometric center early as it was 30 min drive from my home. I must say exam center is located in a very calm place so that helped!! I had some chocolates, biscuits, chips, red bull 🙂 Beware red bull will not give you wings 😛 Started exam and took 2 blocks straight away! I had 15 min left after i completed first block and 10 min after i completed second one so everything was going good LOL although exam was difficult and in my opinion questions were different from NBME and even UWORLD. Questions required more integrated thinking and deep and complete knowledge of the subject. They were essentially checking your basics in a more difficult way than UWORLD.. Got my first break and then break in every block and exam ended in no time and i didint have an idea what happened in that 8 hours and i think have put my best effort in exam. I had no problem managing time and had 5 min left even in last block. There were some genetics that were completely WTF type and i had to make a blind guess. There were many anatomy questions too. For me biostat was very difficult as they were comparing diff studies and i had no idea what so ever which option to choose otherwise exam was pretty much justified and had every high yield topic in it. Exam was simply about how deeply you know the some high yield topics!! I think UWORLD and FA covered 80% of the exam.

Final Score: 236 🙂


UWORLD Performance Chart



  • Do questions as much as possible.. If you have time then do UWORLD, Kaplan and Rx Questions but donot underestimate the importance of UWORLD ever!! Its the best source available
  • Find some study partner which will really help you with memorization and understanding the concepts easy but choose wisely..
  • Use FA as early as possible. Understand and search its every single point. I read FA 6 times but really number of reads don’t really matter but how you understand the book really matter so keep it in mind.

Recommended Books:

  • First Aid for USMLE Step 1 (Bible for step 1)
  • Anatomy: For Gross Netter Atlas plus FA. High Yield Neuroanatomy.
  • Biochemisty: Kaplan plus videos
  • Physiology: BRS physiology.
  • Pharmacology: Kaplan with videos
  • Pathology: Pathoma videos plus goljan book.
  • Micorbiology: FA is more than enough with UWORLD questions
  • Immunology: Kaplan videos plus FA
  • Biostat/B.S. : Kaplan with videos
  • 100 Ethics Cases by Conrad Fischer
  • UWORLD Biostat Course


There is a myth here in Pakistan that do not appear for USMLE Step 1 within your graduation. Its totally wrong. Doing step 1 early saves you a lot of time and it can help you to get electives too. Here is Dr. Ayaz says about it and could not agree more:

This is so prevalent in Pakistan it’s almost pathetic. One of the biggest concerns surrounding our students is that Step 1 is a huge risk to be taken before graduation. Let me put it in another way: Step1 would always remain a risk whenever it is taken, whether during or after graduation, whether with a preparation of 4 months or a preparation 14 months. It is an unpredictable exam. Let me reassure you that taking Step1 within your graduation would, 90% of times, result in a score that would be substantially higher than when having taken after your graduation. Why? It’s simple! You have a habit of studying for prolonged time periods and you haven’t yet stepped into your professional field. Furthermore what you have been studying all along during your medical studies is still fresh in your mind. Basic sciences is something that troubles even the experienced doctors, let alone a mere young student. It’s all about finding the right tempo to study for extended time and when you enter the profession, that is something quite troublesome. Take my advice: rather than wasting your time during your medical studies, spend it swimming through Step1 recommended textbooks. Remember you are in direct competition with medical students of US. They typically appear for Step1 at the end of their 2nd year and Step2 at the end of their 4th year.


Be confident and believe in yourself. Your approach may be different to exam but it doesn’t mean its wrong. Make your plan according to yourself and not based on what worked best for every one else!!

If you have any questions you can ask in comments.

Good Luck for your exam.