In the following text I will be describing my preparation plan. It is actually nothing more than the compilation of advice given by lots of students in this forum, to whom I am really grateful. Because many of you sent me personal messages asking for personal advice, I will highlight the fact that what worked for me may not work for you.

That being said, I consider it important to describe my background. I just finished the 4th year of a 6-year medical degree in a European medical school. I took the test in May 2013, having started my preparation in September 2012. At that time I had just completed the first 3 years of my school, which in my country cover the preclinical subjects. So while preparing for the Step 1, I was also doing my first rotations in internal medicine and surgery. That turned out to be really helpful, given the increasingly clinical orientation of the exam, as I got familiar with the basic signs and symptoms of diseases. However, I had already bought some usmle-style books in the earlier years, to help me tackle my university exams. For example, I had already studied Microbiology Made Ridiculously Simple and Lippincott’s Pharmacology, but not with the purpose of preparing for the step 1.

My preparationI started my preparation in September 2012. I tried to study 5-6 hours a day until January, when I completed the first pass of the material I had bought for my preparation. For each subject I would first read a review book and annotate the missing information into First Aid. I would then do all the questions in uw ( I had a 6-month subscription starting in November) on each subject (subjectwise-timed/unused mode) and add notes in FA. At that time, I would not bother about my scores or memorizing information. It was all about understanding mechanisms, getting familiar with the topics covered in usmle AND annotating in FA. Guys, I think this was the most important thing I did in my early preparation. I would annotate all mechanisms, new drugs etc mentioned in review books in first aid, so that I would not have to go over those books again. I never made notes in these books, nor read them a second time. By January, I had my first aid stuffed with extra information, but I knew that all I had to do was learn everything in this book and practice questions. It is much

easier when you have one book, rather than a series of review books. So starting in February 2013, I started reviewing FA over and over again. Having concentrated a huge amount of info in just 500 pages, I was able to go over the material 4-5 times until April. I would study 8 hours a day, splitting my time in 5 hours of FA studying and 3 hours of practicing question banks. In my case, memorization requires repetition. I have really moderate memorization skills, but after reading the same material 4-5 times I could remember every single page on my first aid book. There were only 2 exceptions to this method: one was Goljan RR, I would not bother annotate it into FA, but what I did was annotate interesting points in the blue margins so that I would later be able to go over it just by reading those margins. The second were the Microcards, which I used instead of the microbiology section in first aid.During the last 4 weeks, I studied as much as I could each day (10-12 hours) and divided my time equally between studying FA and doing practice questions.

Books usedFA: the absolute guide to USMLE step 1. it is not enough if you are aiming for a high score, but you d better know every single piece of information in it if you want to ace the exam.

Pathology: I spent a whole month studying this subject. For each chapter of Goljan’s RR I would first watch the Pathoma videos, then listen to the audio lectures of dr Goljan and then finally read the chapter. I found this approach really useful, but it is indicated only if you have lots of time and a weak background in pathology.

Behavioral science: As a foreign student, this was by far my weakest area. I used BRS pathology. A great book but didnt really help me as far as the ethics questions are concerned. Luckily a few weeks before the exam, a friend recommended the «Kaplan medical ethics: the 100 cases you are most likely to see on the exam». The questions under this topic are not really hard, but require some experience that you gradually acquire after doing lots of questions.

Biochemistry: I used Lippincott’s Illustrated Reviews, a lengthy book but with nice text and tables. However, as I mentioned, I never read those books twice, but on the contrary I made

annotations into FA

Physiology: I used BRS Physiology. short, concise, but you may need something with longer explanations if you are weak in this subject

Molecular Biology: I used HY cell and molecular biology. Maybe the worst book of the HY series I used. It has trivial information and most topics are also covered in other subjects eg biochemistry, immunology...

Pharmacology: I used Lippincott’s Illustrated Reviews. It is a nice book, but not suitable for step 1 preparation. I made some annotations into FA, but ended up learning only the stuff already mentioned in FA and that worked fine.

Microbiology: During my Microbiology classes I had used CMMRS, which is an EXCELLENT book. After the first reading, you can use the summarizing tables found at the end of each chapter. However, I used instead the Microcards. Those cards are AMAZING! They have wonderful algorithms and trees and are the most useful tool in memorizing bugs.

Immunology: I used HY Immunology. Not a great book, but didnt find anything better. Not sure if you really need something more than the first aid immunology section. Do not forget to create a list with all the important CDs, these are frequently tested!

Anatomy/Neuroanatomy/Embryology: I used the HY series. I found those books great, especially the one for Neuroanatomy. (do not worry about anatomy, it is a huge subject and HY gross anatomy may also be a little too detailed. But a quick read of this book, in combination with the anatomy info in FA is all you need)

Question banks/ NBMEs:Doing a massive amount of questions is probably what can boost your score more than anything else. These help you adapt and use your knowledge. It doesn't matter if you know everything in first aid by heart, if you cannot recognize the buzzwords in the question stems or apply the info learned to a clinical vignette. That’s where question banks come in.

I used 3 question banks, UW, Kaplan and USMLERx.

UW is by far the best of the three! Excellent questions, wonderful explanations, it is a major LEARNING tool. Do not use it as an assessment tool! Read the whole explanation in order to learn, even if you got the question right. I first did it subject-wise after finishing each review book and had an overall score of 84%. I also used it during the last 3 weeks, doing 3-4 blocks a day as by that time I had forgotten most of the questions (94%). But as i said, do not worry about your scores, especially at the very beginning. Those questions are really harder than the real test, so do not use them to predict your performance.

KaplanQBank: a very good qbank, definitely use it if you have the time and the money. I made an one-month subscription around April (one month before my exam) and completed 3-4 blocks a day. Overall score=92%

USMLERx: I subscribed for one month in February. It may help you consolidate the info in First Aid, but other than that it is worth neither the time nor the money. I used it because I wanted to practice some questions, while still in the beginning of memorizing first aid, after having a done the first pass of UW.

NBME: Those are the only accurate predicting tools! I took the following:

NBME 6: 650 (2,5 months before the exam date) =259NBME 7: 700 (2 months <<) =268NBME 12: 700 (1,5 month <<) = 268NBME 15: 710 (3 weeks <<) = 271

The rest can be also found offline, but it is up to you, because they are neither legal nor predictive.

I would personally recommend doing all NBMEs but If I were to choose only one, I would choose NBME 15, as it had longer questions stems and was more similar to my real exam. But all of them are quite accurate in predicting your performance from what i hear.

The real examThe hardest part of the exam is trying to maintain your concentration and focus for 8 hours in front of a computer screen. Stupid mistakes are inevitable but there are some ways to minimize them. These are: practice, practice, practice! Try to simulate the exam at home using a question bank or an nbme exam. I simulated a 7-block exam at least twice so that I would increase my stamina and learn how to cope when my mind gets tired. Try to save energy: when facing a long question stem, first read the last sentence to see what it is all about. Sometimes the long stem is just a distractor. Never spend much time on a question you do not know. Guess an answer, flag the question and come back later once you finish all other questions. Practice will help you read through stems quickly, finish the block with some minutes to spare and go once again over the marked questions. I usually marked 8-9 questions per block, but in most cases what seemed to be a weird hard question, turned out to be a simple question addressed in a complicated way. Even in hard questions I was almost always able to narrow down to 2 choices and then take a good guess. USMLE is nothing more than a test, so a good test-taking strategy is as essential as having the appropriate study material. Pathology /pathophysiology dominated my exam but all other topics were relatively equally represented in my exam. There were a lot of tables and graphs, CTs and CXR for Anatomy, simple ethic questions, lots of immunology, but as every single exam is unique I don’t see a point in going further into detail.

Finally, here are some bullet points with the most important conclusions drawn from my experience:

• Set a goal early in your preparation. Even choose an exam date early in advance. Establish a program and a daily routine and stick to it! You do not have to sacrifice other things, such as friends and family, if you organize your time properly. You will also never feel fully confident to take the test, so delaying your exam is not always a good idea. • Try to annotate information from various sources into a major one (eg FIRST AID) . This may be time consuming in the early beginning, but you will recognize its value later on, as you will be able to cover a huge amount of information in a short space of

time.• Do questions, questions, questions: online Qbanks, Qbooks, Nbmes, although expensive, are definitely the most useful preparation material together with the first aid book.• Always try to understand the underlying mechanism of disease! Always ask your self “why is this happening?” when studying. Pure memorization is not so frequently needed, it is your understanding that they want to test.• use your question banks to learn and nbmes to predict your performance!• Feel confident, it is totally doable once you set your goal and work for it!