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The posts collectively highlight preparation strategies, challenges, and triumphs faced by students tackling the USMLE Step 1. Common resources include UWorld, often cited as the gold standard, with completion rates ranging from 35-100%, alongside NBMEs (24-31), Free 120 (Old/New), and Mehlman PDFs for high-yield content. Scores mentioned for readiness typically range from 58% to 87% on NBMEs and Free 120, though some users passed with lower scores. Additional tools like First Aid, Pathoma, and Dirty Medicine help fill content gaps, while resources like Amboss and Bootcamp provide alternatives or supplements to UWorld. Exam strategies prioritize confidence, consistent review, and targeting weak areas.
Recurring themes include the mental toll and burnout during preparation, with many users describing exhaustion near exam day despite achieving respectable practice scores. Others share stories of struggling with lower scores or limited preparation time, offering hope and advice to peers with similar concerns. Some users underscore the unpredictability of readiness and success, emphasizing confidence and persistence as critical factors over perfect preparation. Discussions also stress the need to review NBME content repeatedly, as real exam questions often reflect these concepts.
Administrative issues, such as application rejections and technical problems, further complicate the journey for some students, particularly IMGs. These posts encourage direct communication with ECFMG or Prometric to resolve issues. The community generally offers practical advice, motivational anecdotes, and shared resources to guide others, balancing preparation with mental well-being and emphasizing flexibility to adapt strategies as needed.
Resources
UWorld: Primary question bank with comprehensive concepts, suggested early use and repeated reviews.
NBME Assessments: Key predictor of performance, Forms 25-31 recommended for practice.
Mehlman PDFs: High-yield topics like biochemistry, neuroanatomy, and HY arrows.
First Aid: Used for foundational knowledge and ethics preparation.
Pathoma & Sketchy: Focused on system-specific reviews (e.g., renal, heme/onc).
Amboss: Ethics, biostatistics, and question banks for reinforcement.
Dirty Medicine Videos: Ethics and biochem-focused visual learning.
Anki Decks: Highly customizable flashcards for review; Anking specifically recommended.
Bootcamp & Randy Neil: For specific systems (e.g., cardio, immunology) and rapid reviews.
Ninja Nerd Videos: In-depth physiological explanations.
Scores and Key Metrics
Suggested readiness: NBME scores above 65% and Free 120 above 60%.
NBME averages: Low scores (~50%) can improve significantly with structured preparation.
UWSA Scores: Aim for 70%+ closer to the exam date.
Methods and Strategies
Review weak areas thoroughly using NBME incorrects and system-specific material.
Focus on conceptual clarity rather than volume—consolidate knowledge before adding new resources.
Use Anki for daily spaced repetition; prioritize high-yield and weak areas.
Incorporate UWorld explanations to grasp critical concepts beyond questions.
Build a solid ethics foundation through UWorld, Amboss, and supplemental videos.
Opportunities and Tips
Prioritize NBME review for key concepts—real exam mirrors these heavily.
Ethics and biostats are often straightforward on the exam but require familiarity through practice.
Confidence and mental preparation are critical; burnout can be mitigated with breaks.
Structured support networks, such as Discord communities, offer peer motivation and resource sharing.
Post 1: Passed with dogshit scores
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This post shares the journey of a student who passed the USMLE Step 1 despite having low scores throughout preparation. The author emphasizes that perfect preparation is unrealistic and encourages others to take the exam despite self-doubt. They detailed their struggle with retaining concepts after a break, the slow improvement on UWorld and NBME tests, and last-minute use of Mehlman’s high-yield materials. The exam was tough, but they passed, emphasizing perseverance and confidence.
The comments reflect a mix of support, shared experiences, and caution. Some users related to the author’s journey, sharing similar experiences of passing with suboptimal scores, while others cautioned against encouraging such risks, citing fail rates. Specific advice like focusing on Mehlman’s biostatistics and ethics materials emerged, with users recommending targeted study approaches. The thread serves as reassurance for students struggling with confidence.
Post 2: 18 days out, what should I do with my remaining time?
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The user outlines their preparation progress (84% UWorld completion, NBME and UWSA scores) but is feeling burnt out and studies only two hours a day. They ask for advice on prioritizing tasks in the last 18 days, with plans to take NBME 30, 31, Free 120, and possibly UWSA3.
Advice is centered on confidence-building and targeted reviews. Users suggest focusing on high-yield First Aid topics like pharmacology, biochemistry, and hematology, and avoiding new material. There’s an emphasis on consolidating strengths and reviewing weak areas through tools like Pathoma and UWorld errors. Comments also highlight the psychological aspect—relaxation and confidence—as critical during the final stretch.
Post 3: Rejected USMLE Step 1 application
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The author shares their frustration after their USMLE Step 1 application was rejected due to incomplete transfer credit documentation. They seek guidance on how to amend the application and navigate the technical issue of editing unmodifiable sections.
Responses suggest contacting ECFMG directly for assistance, as the process often requires personalized guidance. Users share similar experiences, emphasizing that phone support or faxing documents can resolve such issues efficiently. The advice underscores the importance of proactive communication in overcoming administrative hurdles.
Post 4: Does anyone know what NBME score correlates to a 70% chance likelihood of passing Step 1?
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The user asks about the NBME score threshold corresponding to a 70% chance of passing Step 1, as required by their school.
Responses clarify that NBME scores around 55% EPC correlate to a 70% passing likelihood. The thread highlights how schools and students interpret predictive scoring metrics to gauge readiness, with NBME’s probabilistic approach often being a helpful tool.
Post 5: Passed with low NBME average
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The author shares their experience of passing Step 1 with low NBME averages. They detail their intensive study routine, including Anki cards, UWorld, Pathoma, and Mehlman’s materials, and their approach to repeated practice despite low early scores. They stress the importance of persistence and confidence.
Many users admire the author’s dedication, asking for Anki deck details and study strategies. The thread is motivational, showing how consistent effort and strategy adaptation can overcome initial setbacks. Users discuss the challenge of maintaining high daily Anki volumes and balancing review with new learning.
Post 6: Non-US IMG failed Step 1
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A non-US IMG shares their disappointment after failing Step 1 and seeks advice on whether they can continue their medical journey despite the setback.
The discussion is empathetic and realistic, emphasizing that a strong Step 2 score and building an impressive CV can mitigate the impact of a Step 1 failure. Users highlight the importance of persistence and alternative career paths, encouraging a growth mindset while acknowledging the challenges ahead.
Post 7: I have only 1 month to exam. Should I just not take it?
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The author, feeling unprepared with 54% UWorld completion, asks if skipping the exam would be a red flag. They are extremely anxious and seek assurance about their readiness.
Responses advise the user to evaluate readiness using NBME or Free 120 scores rather than UWorld percentages. The community emphasizes that incomplete UWorld does not equate to failure if other predictive metrics indicate passing potential. Practical and motivational advice helps ease the author’s anxiety.
Post 8: Step 1 advice
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The user seeks advice on the most frequently tested topics in NBME 30 to prioritize their study plan, especially with their exam in 15 days.
Users recommend avoiding the temptation to narrow focus to specific NBME topics, as this can give a false sense of readiness. Instead, reviewing past mistakes and high-yield topics ensures better overall preparation. The advice reflects the importance of comprehensive readiness over targeted guessing.
Post 9: Advice on Study Methods
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A non-US IMG shares their struggle with low UWorld and NBME scores. With three weeks left in their UWorld subscription, they seek guidance on maximizing their remaining time to feel confident in their progress.
Suggestions focus on reviewing UWorld incorrect answers and consolidating concepts with First Aid and videos like Boards and Beyond. Comments emphasize the need to develop strong conceptual understanding before relying on resources like Mehlman PDFs. The importance of efficiency in time management and active learning is repeatedly highlighted.
Post 10: A bit worried
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The author shares post-exam concerns about not ending blocks manually due to time constraints and asks if answers save automatically.
The community reassures the user that answers are auto-saved, alleviating concerns. The thread highlights common post-exam anxieties and the supportive role of the online community in addressing these worries.
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Post 11: Losing Motivation
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The user has been preparing for Step 1 since March and is scheduled to take the exam in 28 days. They express feelings of burnout and low motivation, despite achieving a 72% (234) on UWSA2 and planning to take additional NBMEs. They seek advice on coping during the last stretch.
The thread is filled with advice emphasizing mental health and strategic study. Users recommend taking short breaks to recharge, focusing on NBME concepts, and using resources like Mehlman PDFs. Some share similar struggles, while others highlight the importance of maintaining confidence and avoiding burnout before the exam. The discussion underscores the emotional toll of prolonged preparation.
Post 12: Passssed!
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A fourth-year IMG shares their success story after 9 months of preparation. They attribute their success to resources like UWorld, First Aid, and Mehlman’s PDFs, which they found critical for topics like neuroanatomy and biochemistry. They emphasize that mastering UWorld concepts is key and share insights about the dumb vs. smart option strategy for test day.
The comments are filled with congratulatory messages and requests for advice. Key points discussed include time management during the test, the reliability of UWorld, and the value of Bootcamp for specific systems. The conversation highlights the importance of strategy, consistency, and resource selection in achieving success.
Post 13: 3 Months Before Test, Feeling Lost
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The user struggles with low UWorld scores (43% average) and inconsistencies in diagnosing conditions correctly. Despite using Pathoma, Sketchy, and Anki, they feel lost and seek advice on improving their approach with three months left before the test.
Users recommend focusing on weak topics using UWorld reports and supplementing with targeted resources like Bootcamp or AMBOSS. Some suggest creating personalized Anki cards to address specific knowledge gaps. The advice emphasizes developing a conceptual foundation rather than focusing solely on question banks.
Post 14: Think I Am Going to Defer
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A non-US IMG balancing emergency department work and Step 1 prep considers deferring their December 4th exam due to poor performance on practice tests and lack of confidence. They plan to retake the test in February after reducing work commitments.
The community agrees that deferring is wise given the challenges of balancing work and preparation. Suggestions include reviewing NBMEs and Mehlman PDFs while maintaining a steady study pace until dedicated time begins. Users emphasize that confidence is essential, and taking the exam underprepared risks long-term setbacks.
Post 15: Score Report Error
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The user believes there was a mistake in their Step 1 score report, as they scored well on NBMEs (70–75%) but received a failing result. They submitted a re-evaluation request and are seeking advice on how to proceed.
The thread discusses the potential for technical errors at testing centers and the importance of ensuring fair re-evaluations. Some users speculate on the integrity of certain testing sites, while others caution against paranoia fueled by Reddit posts. The thread underscores the anxiety surrounding unexplained score discrepancies and the importance of reaching out to Prometric or ECFMG.
Post 16: Help
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The user, with 20 days until their exam, has completed only 20% of UWorld but scored 68% on NBME 27. They are unsure whether to proceed with the exam or postpone it.
Responses suggest prioritizing NBMEs and Free 120 for assessing readiness, rather than focusing on UWorld completion. The consensus is that consistent NBME scores above 65% indicate adequate preparation, and additional UWorld use at this stage is less critical than consolidating weak areas.
Post 17: Old Free 120
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The user asks whether the old Free 120 is a reliable predictor for Step 1, having scored 67% with six days left until their exam.
The general advice is to focus on the new Free 120, as it better reflects the current exam format. While the old version can provide additional practice, users emphasize the value of more up-to-date predictive tools.
Post 18: What Should I Do?
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A non-US IMG who failed Step 1 asks whether they should give up their dream of matching into general surgery or consider alternatives.
Responses are realistic but empathetic. Users caution that matching into general surgery with a failed Step 1 is exceptionally difficult, especially for non-US IMGs, but not impossible. They recommend focusing on Step 2 CK, strengthening their CV, and considering alternative specialties like Internal Medicine or Family Medicine.
Post 19: Biochem
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The user asks whether UWorld is sufficient for mastering biochemistry on Step 1.
Most agree that UWorld is comprehensive for biochemistry if explanations are thoroughly reviewed. Additional resources like Mehlman PDFs and Pixorize are suggested for difficult concepts like enzyme deficiencies. The discussion highlights the importance of retaining conceptual knowledge over memorizing extensive details.
Post 20: How Will I Know If My Permit Disappeared?
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The user, who tested on October 24th, has not received their Step 1 results yet and wonders if the disappearance of their permit indicates that their results have been released.
Users clarify that the disappearance of the permit typically signifies that results have been released, but delays can occur. The discussion reflects common post-exam anxieties and the importance of contacting ECFMG for clarification if results are delayed.
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Post 21: ANKI/Plan Advice to Pass This Thing
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An M2 student plans to use ANKI, AMBOSS, and UWORLD to prepare for Step 1 over the next 180 days. They aim to study 500 ANKI cards daily, complete the UWORLD QBank, and balance current coursework. They seek advice on the plan's feasibility, the best ANKI decks, and other strategies to ensure a first-attempt pass.
The Anking deck is universally recommended as the most comprehensive and efficient ANKI resource for Step 1. Suggestions include pairing card reviews with relevant lectures (e.g., Pathoma) to reinforce concepts. Emphasis is placed on daily consistency with ANKI and strategic use of UWORLD to solidify weak areas. The advice balances ambition with practical tips to avoid burnout.
Post 22: Need Info
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The user inquires whether the Federation Credentials Verification Service (FCVS) is functional for Step 1 results.
Responses clarify that FCVS works only for older accounts. For newer accounts, results are released through ECFMG email notifications. The discussion highlights the process's limitations, especially for recent examinees relying on newer systems.
Post 23: Step 1 Ethics
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Observing an increased emphasis on Ethics and Communication questions in the Step 1 exam, the user asks for the best resources to strengthen their understanding.
The First Aid ethics section, Dirty Medicine videos, and AMBOSS are the top recommendations for mastering Ethics. UWorld is emphasized as the gold standard for practice, with supplementary materials used to fill gaps. The thread reinforces that consistent practice, especially with ethics patterns in UWORLD, is key.
Post 24: Someone Please Explain Why Thiazide Diuretics Increase Calcium Reabsorption While Loop Diuretics Decrease Reabsorption
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The user is confused about why thiazide diuretics increase calcium reabsorption, while loop diuretics reduce it, and seeks a clear explanation of the mechanisms involved.
Responses emphasize understanding the location-specific mechanisms in the nephron. Key explanations include the role of the Na+/K+/2Cl- transporter in the loop of Henle and the Na+/Ca2+ exchanger in the distal convoluted tubule (DCT). Resources like Ninja Nerd videos and UWorld are recommended for deeper understanding. The discussion is highly technical but effectively clarifies a common point of confusion.
Post 25: Step 1 Without First Aid?
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The user asks whether it is feasible to pass Step 1 without using First Aid, given its widespread use as a core resource.
Comments suggest that while First Aid is not strictly necessary for those with a strong foundational knowledge, it remains a useful tool for mnemonics and prioritizing high-yield topics. The discussion reflects a growing trend of students using alternative resources like AMBOSS, UWorld, and personalized ANKI decks, though First Aid remains a highly recommended guide for many.