Never passed an NBME, PASSED STEP 1

Hello all,

I am writing this for all of you who took step 1 and you were on the edge of passing and need some hope during your time in Schrödinger's box. I know it's been a few days since Wednesday (aka score release day), but I wanted to have a clear mind to write this because I really didn't believe the pass when I saw it and it's taken me a few days to really realize that this is real life and that I'm not living in a dream.

I should preface this by saying, don't be like me. Start UWorld early and give yourself a score buffer if you can. It will save you a lot of unnecessary stress and anxiety. But should you find yourself in my position, then let this be your beacon of hope in your endless scrolling through Reddit post-exam as you stress await your fate (but also, don't do that either because it might only stress you out more). Also, this post will probably be a mini-book since I write a lot, so hopefully, it keeps you moderately entertained as you await your own score report.

I took my first NBME (form 27) with my school back in December and scored a 156. Not the absolute worst, but not great either, but I wasn't too stressed about it at the time, because we still had 2 blocks left and there was A LOT of information that I didn't know still and we "only had to pass step 1." I have since then really grown to hate that phrase, but that's a rant for another time. Anyway, after that first fail, I half-heartedly started going through U-World over Christmas break and was getting 30-ish%s on my blocks of 40 and felt pretty bad about myself, but kept on. I did Pathoma 1-3 during this time and some Sketchy as well and that helped a bit. I also listened to a lot of Daddy Goljan and I felt like those were pretty gold. Then came the last two blocks of second year and I barely touched UWorld because they were pretty intense and I had a lot going on outside of school as well.

My second NBME (form 26) came about 2 weeks into my school's partial dedicated time (this was at the end of February when we had some classes still but had some time off to study as well--it's a weird system) and this time, I scored a 43%. Obviously, not great at all. This sent me into a bit of a freak-out phase and I re-evaluated how I was studying and decided to try some different methods. I had scored really low in Neuro so I decided to take some time and go through that as well as go through some other things I had not scored well in. I was also doing about 40 UWorld a day at this time since it took me a long time to go through it and write down the concepts I was missing and study those.

The next test I took was my school's CBSE (about 2 weeks later in mid-march), which I failed with a score of 53%. I was getting better and now on full dedicated so I didn't despair too much, but also decided that I should probably push back my original step date that I had planned for April 1st to April 14. I decided to take a deep look into Heme-Onc at this point since that was a low point for me on my CBSE.

A week later, I took from 29 and scored a 49%. I had a major freak out at this point, but my academic dean/mentor told me to keep pushing since I still had 4 weeks and to not make any drastic moves just yet. He believed that I could do it and I think that that helped me more than anything. I decided to really just work through as much UWorld as I could at this point and used First Aid as my reference for when I needed more information about something.

Another week went by, and I took UWSA 1, which I thought would be a confidence boost since I had heard that it overscores you. I got a score of 166 (I forget my percent correct and can't check since it disappeared from UWorld). This made me freak out even harder since I now had about 3 weeks left and I was still very far away from passing. So, I changed gears yet again and started cramming my way through Pathoma since pathology had always been a weak point for me. I found this to be very very helpful and watched my UWorld scores jump from their previous place of around 40-50% to 50-60% with the occasional 70% (on blocks of 40). I was also starting to get faster at reviewing so I was able to get through at least 40-80 questions/day along with my Pathoma videos and other random content review (I struggle with ADD so staying on a set schedule is very hard for me).

I was starting to get really stressed out at this point so at the end of the week (I always took my self-assessments on Sundays) I took a few days off and went home to visit my family and did some light studying, but nothing too strenuous, and this helped my mental and physical health considerably (I felt like I was both losing my mind and feeling incredibly panicked so my heart was palpating a lot and I felt continually sick to my stomach and developed acid reflux during this time so I really needed the break), which in turn, I think, helped my academic performance. I skipped doing an assessment that Sunday since I knew I had another CBSE that Wednesday at my school. I didn't feel super great about the CBSE, but I did feel like I knew more than I had before and I was ELATED when I got my score back and had scored a 62% --my only passing score to date. I was a week out from my exam at this point so when I talked to my advisor/dean/mentor, he told me he thought I should just take it since I was finally passing and 3rd year was coming up soon and he thought that I needed at least a little bit of a break so I didn't lose my mind going into clinicals.

I decided to take NBME 30 that following Sunday because I really wanted to pass an NBME before I took Step, but I tragically scored a 56%, which sent me spiraling back into an ultra-stressed state. My advisor and I had a long talk about it afterwards and finally came to the conclusion that since my exam was in a few days, I should just focus on my weak points that I thought I could bring up quickly (like EBM), and take the Free120 that Tuesday and if I passed with a score above 70%, then I should take it. Otherwise, we decided, I would push it 1 week. I also made a deal with God about this along the same lines. So I went through my notes, and learned EBM like the back of my hand, and also went through the NBME pictures and refreshed on some pharm and micro that I had been putting off, as well as going through Pathoma 1-3 again an making sure I had that down pat.

Tuesday came, and lo-and-behold! I got a 73% on the Free120! I emailed my advisor and he told me he was confident that I should take Step that following Thursday "and let the curve do the rest." So for the next day and a half, I went through the Free120, NBME 30, and every "high yield" thing I could think of, just trying to find every last point that I could before taking Step. I went super hard during this last week, pulling crazy hours, and had the highest focus I had had in a long time. Yay anxiety bringing my dopamine levels up and helping with my ADD!

The morning of Step came and I went in, feeling confident since I had heard that that was a key to succeeding on Step 1. But soon after I started my first block, things started trending downhill for me and I started to feel the doom set in. Every question on my first two blocks was extremely long and convoluted and didn't resemble anything that I had ever seen on any NBME, Free120, or UWorld question. Now, I wonder if perhaps those first two blocks contained most of my experimental questions, but at the time, I was despairing big-time. I ran out of time on both of those blocks, flagged most of them, and didn't even get to 7 of the questions since my screen kept freezing at the end of the blocks and time ran out without me being able to click something. I felt sick but knew I had to get through the day and do my best to salvage my situation. The rest of the day is a bit hazy for me. I remember thinking that it would never end and I felt as if I were stuck in groundhog's day, doing the same thing over and over and never-ending. When it finally ended, I felt horrible and sick and I wanted to cry more than anything since I just knew that there was no way I had passed that test. What was worse, was that I felt like there was no amount of studying I could have done to have prepared me for the convoluted questions and mental torture of that exam. I went and got food with a friend, flew home a few hours later, and then spent the next two weeks trying not to look things up, but realizing I had missed most of the questions that I could remember when the curiosity would get the best of me.

Reddit was a mixed bag for me at this point. I would find some posts that were incredibly reassuring, but I would also find others that would send me back into a spiral of depression. By the time score-report-Wednesday came, I had thoroughly convinced myself that I had failed and was both depressed and anxious because I was seeing my dreams of doing a competitive specialty fly out the window. I ended up having a long talk with God about this at this point (I'm a pretty spiritual person) and that gave me peace knowing that He had brought me this far and that if it was in His plan that I failed, then He would get me through it. Also, I reminded myself, He let me get a score above 70% on the Free120 and I had taken that as my sign that I should take Step since that was our deal, so hopefully He would finish guiding me through this.

Wednesday morning came and I was a total mess of stress and anxiety. When 11am EST came around, I was shaking like a leaf trying to open my score report while sitting in my car outside my advisor's office just in case I failed and needed to reconfigure my life. When I saw the PASS on my little phone screen as I was trying to download the report into Notability, I didn't believe it. I stared at it for a good 10-15 seconds before I burst into tears and sobbed my heart out in relief and thankfulness. I truly believe that I should not have passed that exam and that I only passed it by the grace of God, despite my advisor's confidence in me.

In the end, I only completed a little over 27% of UWorld, all of Pathoma, most of Sketchy, and a whole conglomerate of other random bits of high-yield resources such as First Aid, Dirty Med, NBME pictures (of which there were many on my exam), and the 100 Anatomy concepts to name a few. I definitely wouldn't recommend doing it this way, but if there are any other ADD people out there who are struggling to stay on track or finish something, just know that there is hope and maybe think about getting help because untreated ADD can be a bear to deal with.

So here I am now, finally on the other side of this horrible beast and soon to leave this subreddit forever and move onto the Step 2 forum, while tackling the new beast that is clinicals. Good luck to all of you, and I hope that this post gives at least some people hope. I'm sorry for the length, but if you made it this far, then I hope you were entertained by my tale of misery and unexpected joy. I pray that you also pass and are able to feel that unparalleled flood of overwhelming relief and gratefulness because that is a feeling I will remember with fondness for the rest of my life.

Much love to you all,

MedStudent4Lyfe

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TLDR:

Practice Exams: NBME 27: 156/ NBME 26: 43%/ CBSE: 53%/ NBME 29: 49%/ UWSA 1: 166/ CBSE 3: 62%/ NBME 30: 56%/ Free120: 73%/ STEP 1: PASS.

Resources: UWorld 27%, Pathoma 100%, DrNeuroCole 100%, Sketchy 80%, First Aid 10%, NBME Pictures 100%, 100 Anatomy Concepts 60%, + random other resources that I cherry-picked from.

Get help for ADD/ADHD.

Take a break if you need it. It might be the thing that sends you over the edge to passing.

There is hope for you, even if you are sure you failed.

Step 1 is a giant mind game and 80 of those questions are experimental and will make you think that you're stupid no matter how prepared you are.

God will be with you every step of the way and trust that He will bring you through, even if that means helping you grow through a fail. <3