My Step 1 Experience, Dr. George Koshy

georgeStudying for USMLE Step 1 has been one of the most satisfying periods of my life.

I started my preparation on May 31st, 2016. I had all the required study material but no specific plan to move ahead. I was in a time-crunch, and I needed a solution. Two weeks after attempting to memorize First Aid 2016 aimlessly, I watched a video on Facebook by the Osmosis team. It described an intriguing interface with all study materials with a day-by-day plan. Out of curiosity, I created the account and delved into it right away. Since then, my journey with USMLE Step 1 has been fruitful and an absolute joy. I selected the 3-month study schedule as I wanted to give my Step as soon as possible. I then selected the resources I wanted to use. I used First Aid (2016), UWORLD and Pathoma text and videos. Everyone uses these resources, there are no other magical resources. But the key is how we use these tools. My Daily schedule was decided by the Osmosis interface. There was a defined number of pages to study from First Aid, then questions from UWORLD, Pathoma text, Pathoma videos and for the cherry on the top – Osmosis questions and flashcards to revise at night. This was pretty much my average day. The best part of Osmosis creating a study schedule for you is that it integrates the basic sciences and the pathology part of it for studying, which makes it all the more easy. For example, if you are learning Immunology from First Aid, the very same day, you will also do Immunology from Pathoma. Doing it this way simply made my life easier. There were days, I felt overwhelmed, so I just added a ‘holiday’ to my study schedule and osmosis automatically reconfigures your schedule so that you don’t have to stress over it. I feel that assessing yourself on the basis of the number hours you put in is not the most accurate way. For me, the main target was to complete the day’s checklist as given by Osmosis. When I completed my checklist for the day, my study was done and I was free to relax afterward. However, on an average it took me about 8-10 hours a day to complete the daily requirements. There are two main types of resources for Step 1. One group is for learning and the other is for testing and evaluation.

About 60% of step 1 is pathology. For an IMG like me, studying pathology was one of the best things I did. Not only did I enjoy the subject, but it helped to make the foundation for many concepts that I would learn in the future. So keep your learning centered around the pathology and pathophysiology of every condition.

  1. My resources for Pathology were: Pathoma text, Pathoma videos and Goljan Rapid Review of Pathology. I did not read the entire Goljan However, what I did read were the margin notes and the summary tables in Goljan. They are like an expresso coffee shot boost during your revision.
  2. The most important resource (Bible for Step 1) is undoubtedly First Aid for USMLE Step 1. It is to this resource that we add everything else. Every single word from First Aid is important, not in the rote sense, but in making the skeleton of information to which we annotate the other resources to make a kick-ass review material. Invest in a physical copy of First Aid.
  3. Question bank: UWORLD is the most important question bank you will need. Use it daily with the subject you have reviewed and make use of it learning tool. On your first round of UWORLD, it’s beneficial to do questions system-wise, timed mode. After each block, read every question and figure out ‘why you selected that particular answer’. Work on your reasoning rather than just getting the answers right. Believe me when I tell you that, it will have a huge impact when you get unknown never-before-seen weird questions on your exam. So even if your answer is correct, read and annotate any extra points to your First Aid for final revision.
  4. Revision: OSMOSIS has an excellent collection of questions and flash cards, use them at the end of the day to revise the voluminous information you have learned. Use the flash cards before you go to sleep and when you wake up in the morning. Commit your learning to your permanent memory. Only then do your efforts become meaningful.

Do not underestimate the importance of revision.

Once you have completed the first round of First Aid, UWORLD and Pathoma along with the OSMOSIS questions, it is time to see where you stand. Purchase a $60 NBME test. Give the exam seriously, and imitate actual exam conditions and breaks. Start with NBME form 12. Use the graph given at the end of the exam to assess your weak areas. Once you have determined those, its’ time to do a second round of First Aid and UWORLD (this time in random blocks). Read up in detail on the concepts that you missed and why you might have gotten them wrong. Once this is complete, give the next NBME form (13).

This is the cycle: NBME Graph->Revise First Aid->Random UWORLD->Revise Osmosis Flash cards->NBME-> Repeat.

Two weeks before test day, finish all your NBMEs and UWSA assessments. The last two weeks are only for revision and not the time to learn anything new. Revise First Aid and keep doing random blocks of UWORLD. But now, practice doing UWORLD in blocks of 7 daily for two whole weeks and review ONLY those that you got wrong. When you task yourself with doing 7 blocks daily, it trains you for the behemoth that is the test day. Before going to sleep, revise Osmosis Flash Cards (this should be a daily routine nonetheless).

The night before test day, sleep well. Reach exam center well before time. I did my blocks in this way: Block 1->Block 2->Break->Block 3->Break->Block 4->Longer break (10 min)->Block 5->Break-> Block 6 -> Break -> Block 7.

All the best!

George Koshy Vilanilam

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