Hi,

I'm currently a 4th year student at UQ. I took the step 1 in December, and got my
score last Wednesday. I am extremely happy about my hard-earned score of
276/99, and would like to share my experience with other medical students
studying for this exam in Australia.
Compared my classmates, I had to spend a significant amount of time on the side
to study for this exam, as the Australian medical curriculum does not place a lot
of emphasis on basic sciences education. The course covers very little
biochemistry, pharmacology, and microbiology, so I spent extra effort studying
for these subjects. I generally don't find lectures useful in med school, and the
greatest piece of advice I've received regarding lectures is to attend them
selectively. I spent a lot of time in second year studying at home as opposed to
going to lectures, and I was able to get through resources fairly efficiently at my
own pace. I also joined a USMLE study group at the beginning of second year,
where a group of my friends would spend an afternoon every Saturday to go over
materials that are frequently tested on the USMLE, especially the subjects
mentioned above. Each person would be assigned a topic, prepare for it during
the week, and give a brief talk on the topic on the following Saturday. I found the
study group very helpful in getting me motivated to study for this exam.
I initially intended to sit the exam at the beginning of third year, so I spent a
month studying after second year was over. At the end of the month, I didn't feel
quite ready and decided to postpone my exam till the end of third year, thinking
that I would have plenty of time to study during the clinical rotations. Wrong. I
only had some time during my rural rotation and psychiatry rotation to study for
USMLE, but could only manage to do 1-2hr/day on weekdays and up to 8hr/day
on weekends. At the end of third year, I spent a month studying hardcore again,
and finally took the exam on the 26th of December.
I've posted my experience in exam preparation below; feel free to PM me if you
have any questions regarding my preparation. However, I'd be grateful if you
could read the Q&A section first before you PM me, just in case I have already
answered it.
=====================
Initial goal: 250+
Total prep time: 1000 hours.
IMG at an Australian medical school (UQ); MCAT=38
NBME 1: 258 (9 months out)
NBME 2: 261 (2 months out)
NBME 6: 262 (25 days out)
UW 1: 265+ (15 days out)
NBME 3: 265+ (8 days out)

NBME 4: 265+ (6 days out)

UW 2: 265+ (4 days out)
NBME 5: 265+ (2 days out)
USMLE CD: 96% (1 day out)
I did over 10000 USMLE-style practice exam questions in the following order:
USMLERx: 94%
Kaplan Qbank: 91%
First Aid Q&A step 1: 93%
UW: 88% (Random, unused, first time through)
Plus NBME + UW exams + USMLE CD + RR Goljan...
Prep material:
FA of course!! I read it cover-to-cover 3 times. However, I tend to cross-reference
it when I read other books and I frequently consulted it during second year
during PBL. I also annotated notes in FA when I did UW, so I was very familar
with the content of this book. For every diagram/table/metabolic pathway in FA,
I made sure that they were familiar to the point that I was able to to reproduce
them from memory.
Anatomy: Kaplan notes & Kaplan webprep, USMLE Road Map Anatomy, HY
Neuroanatomy.
Behavioural science: Kaplan notes & Kaplan webprep.
Biochemistry: Kaplan notes & Kaplan webprep.
Cell biology: HY Cell and molecular biology.
Microbiology: Kaplan notes & Kaplan webprep, Micro Made Ridiculously Simple,
MicroCards.
Immunology: Kaplan notes & FA.
Pharmacology: Kaplan notes & Kaplan webprep, HY Pharm, Pharmacology Flash
Cards (Brenner).
Physiology: Kaplan notes, BRS Physiology.
Pathology: BRS Pathology, Goljan audio, Goljan notes.
Preparation timeline:
During second year - Read BRS Pathology and pretty much memorized the book.
I love pathology so it wasn't really a daunting task for me. I also started listening
to Goljan audios in first year and I was really glad that I started early. I finished
Goljan audios at least three times, but I always felt that I learned something new
each time.
December 2007 - Finished reading Kaplan notes (all subjects except Path) and
Goljan notes for Path. 8-10hr/day. (300hr)
Jan - Nov 2008 - On and off. I did NBME1 in March and got 258(720) and was
pretty happy that reading Kaplan notes paid off. However, I had only about 4
months during this time (rural and psych) where I could fit USMLE studying into
my schedule, but could only manage to study about 25 hours a week. During this

time, I read the supplementary material (HY, Road Map, flash cards), listened to
Kaplan webprep while commuting, and did the majority of the practice questions.
(400hr)
December 2008 - Did most of the NBMEs and UW assessment exams in this
month. Completed UW question bank for the second time. Spent the last week
just memorizing FA and doing practice questions. 8-10hr/day. (300hr)
Exam experience on 2008/12/26:
I started the exam at 8:30 and finished at 4:00 with 20 minutes of break time to
spare. On average, I spent 45 minutes in each block and took a 20-minute break
after each block (except the first block). During each break, I would drink 300mL
of oolong tea or green tea to keep me awake, eat half a sandwich, go to the
washroom, and wash my face so I felt refreshed and ready to tackle the next
block. I thought the strategy worked quite well for me.
I thought the exam was quite a bit harder than NBME but easier than UW. It was
probably comparable to UW self-assessment exams in terms of difficulty. I
marked 6-7 questions each block. I thought 85% of the questions was straightforward, 10% was tricky, and 5% was difficult.
Pathology: Not surprisingly the bulk of the exam. Around 70% of the questions
were patholgy questions or required pathology integration. I thought UW covered
these sorts of questions really well, so there weren't really any surprises for me. I
only had around 5 questions that came with pictures of gross pathology
specimens.
Anatomy/neuroanatomy: 15 questions. Most of them involved intepretation of Xrays/CT/MRIs, nothing too obscure. I even had brain CT and angiograms for
structure identification. Make sure you know the brain stem and cranial nerves
well.
Behavioral science: 20 questions. Half were biostatistics, and the other half were
the typical "what would be the best action/response in this scenario" type of
questions. I thought just reading FA or Kaplan notes was not really sufficient to
answer these sorts of questions. I had almost no questions that came out of the
psychiatry section in FA, except a few psychotropic medications and a question
on defense mechanisms.
Biochemistry/Cell bio/Molecular bio: Geez, I noticed the trend of increasing
proportions of cell biology questions in the NBME, but I never expected this
many on my exam. I probably had 50 questions that fell into this category
(Biochem/Cell bio). I was glad that I flipped through HY Cell and Molecular
biology just a few days before the exam, because it probably helped me answer 5
questions correctly. The different kinds of receptors and intracellular signalling
pathways are extremely high-yield. For metabolism, know the key regulatory

enzymes and global control of metabolic processes (i.e. insulin vs glucagon's

effects).
Pharmacology: Around 25 questions. Piece of cake compared to UW. I thought
FA covers pharmacology in sufficient details. As usual, emphasis was placed on
autonomic pharmacology and cardiovascular medications. I had quite a few
questions on pharmacodynamics too.
Microbiology: 30 questions. Make sure you know the various bacterial exotoxins
and their mechanisms of action. Quite a few questions involved TB and HIV.
Even West Nile virus appeared on my exam.
Physiology: 30 questions. Most involved the up/down arrows and graph
interpretation. Endocrine questions are high-yield too.
I walked out of the testing centre feeling quite confident I did pretty well. I was
certain I broke 260, but wasn't too sure if I was able to get 270+. Got the score
last Wednesday, 276/99! I didn't even know it was possible! Needless to say, I
was ecstatic!!
=====================
I've also compiled a Q&A from the emails and PMs I've received since last
Wednesday. I'd like to thank those who emailed or PMed me and also their
permission to post these questions up. I hope this answers more questions
regarding my exam preparation.
Learning Resources:
Q: What edition of Kaplan notes did you use, and did you use the accompanying
videos?
A: I used Kaplan notes 2004 edition. I was running out of time toward the end of
my preparation so I didn't use the videos.
Q: Did the Kaplan webprep audios make a big difference where the lecture notes
are concerned?
A: I wouldn't say the webprep audios were essential, but they certainly helped
solidify many important concepts, especially for biochem and pharm. If time is a
factor for your preparation, I would suggest doing the webprep audios only after
you finish reading the lecture notes.
Q: First Aid – how much does it cover?
A: FA covered about 80% of the material on my exam, so I would definitely
recommend using it as the primary resource the week before the exam. I went
over the rapid review section at the end of FA the night before the exam date, and
I found it quite helpful as a last-minute review.

Q: Do you think the lecture notes for biochem are okay to use without the videos?
A: I think the lecture notes for biochem are adequate to be used on its own; I
didn't use Kaplan videos so couldn't comment on them. However, I would highly
recommend listening to webprep for biochem. Dr. Raymon is just simply
amazing; he does an excellent job integrating pathology, pharm, and biochem.
However, it is still of utmost importance to memorize all the
tables/diagrams/metabolic pathways in the biochem section of FA. I think it
really ties the information together nicely toward the end of the preparation.
Q: For Pharmacology, do you think studying FA is enough?
A: I think FA is enough for Pharm, provided that you know the mechanisms of
the drugs well. I found it quite difficult to memorize the list of clinical uses and
side effects without having a solid understanding of the mechanisms, so I chose
to do Kaplan notes before tackling FA, and it certainly made those things easier
to memorize.
Q: Did you like the Pharmacology flash cards you used or were they too detailed?
A: I liked the flash cards, they are handy to carry around if you want to study
them on the bus or during a boring lecture. It can also be conveniently used to
quiz yourself, with the drug's generic name and trade name on one side, and the
list of drug class, mechanism, clinical uses, side effects, route of metabolism on
the other side. I don't think they are overly detailed.
Q: Despite reading Microbiology Made Ridiculously Simple over again, I am still
missing tons of micro questions. I dont feel like there is anyway to "master" these
questions cause they often test trivia that while I know I read, I just cant recall on
the spot. Although, I do think my main problem here is focusing too much on
MRS and not on FA.
A: I agree with you that using FA to supplement MRS would be very helpful. It's a
good idea to start with MRS in the beginning of your preparation, but toward the
end, the tables in MRS and the charts in FA are the way to go. A heavy amount of
rote memorization is required to master Microbiology, that's for sure. I would
encourage you to focus on the classifications and lab algorithms first before you
start memorizing the rest of the minutiae. (Remember: Big pictures first!) The
gram positive and negative lab algorithms in FA are gold. Pay close attention to
the bacterial exotoxins as well, because they frequently appear on the exam. Make
sure you know these like the back of your hand. For virology, use the mnemoics
in Kaplan notes to remember the DNA, +RNA, and -RNA viruses.
Q: You mentioned that kaplan and FA were not enough for behavioural and
biostat questions. Any suggestion what shall I go for to cover that?
A: A lot of my friends liked HY behavioural and biostats a lot, but I have only read
the first few chapters of HY BS so I can't really comment on them. I didn't like
Kaplan and FA because they focused too much on the psychiatric disorders, and
not so much on the "best response/action" scenario type of questions. The
practice questions from UW and NBME are very good though, and I would
recommend doing as many questions like those as you can, so you're familiar

with the concepts. Sorry to confuse you, but for biostats, I think FA is quite
sufficient, but make sure you are comfortable doing those calculations and
drawing those 2x2 tables. Doing lots of biostats questions will definitely help
solidify the concepts.
Q: How much do you get through a day and how do you retain that information?
One of my problems is that I get through maybe 30 pages of Kaplan Biochem
notes a day, and at the end of the day, while I retain the information, I find that I
really didnt learn that much. Furthermore more, I tend to forget things as I go.
When I do questions later on on the same subject, I forgot much of what I learned
maybe 2 weeks ago.
A: Don't worry too much about having to retain everything in Kaplan notes, it's
impossible and often unnecessary to try to remember some of the details. I think
the primary purpose of reading Kaplan notes is to help you understand FA later
on so you can memorize the facts in FA with better ease. What types of questions
are you getting wrong, are they questions that require straight fact-recall or ones
that require you to apply a concept? If it's the former, I wouldn't worry too much
about Kaplan notes and would probably spend more time studying FA instead;
for the latter, you do have to make sure you comprehend the info in Kaplan notes
before moving on to FA.
Another thing I found helpful was to read the corresponding section in FA after
finishing a subject in Kaplan notes. It helps solidify information right away.
Q: How many pages of FA and kaplan notes can you get through in a day?
A: I set goals to get through 100 to 120 pages of Kaplan notes every day, at the
speed of 12-15 pages per hour. It depends on the subject too; anatomy and
biochem were slower, whereas physiology and pharm were faster because I had
done BRS physiology and Pharmacology flash cards already. I could read around
60 - 80 pages of FA in a day toward the end of the preparation, but when I first
started, it was painfully slow. I could remember spending an entire day just
studying the embryology section, which was only a few pages long but very
memory-intensive. But once you start remembering the mnemonics and are
familiar with the content, the speed goes up quite quickly.
Question banks:
Q: Did you do questions after each subject during your initial read, or did you
skip questions altogether until after you completed your first read?
A: Thanks for raising this point as I probably didn't make it very clear in my post.
I started doing questions after reading all of Kaplan notes, BRS path and phys,
Goljan notes, and most HY books that I mentioned. The only book that I was still
reading after I started doing questions was FA.
Q: When you say you did 10000 questions, do you include the book questions or
any other questions?
A: I only counted the questions in USMLE format.

UW (2000) + Kaplan practice tests (2000) + Kaplan Q-bank (2000) + FA Q&A

(1000) + USMLERx (did ~2000) + NBME 1-6 (1200) + UW self-assessment 1&2
(400) + Goljan RR Path questions (100) = 10700
I didn't count BRS questions or questions in Kaplan notes because they were not
always in board format.
Q: Did you do robbins review of path? Was USMLERX useful?
A: I didn't do Robbins, and I wouldn't recommend it either. USMLERx was okay
in terms of helping me memorize some details that I wouldn't have paid attention
to in FA, because this Q-bank is basically based on the material in FA.
Q: Would you say that a particular question bank or all the 3 question banks that
you did do cover all the usmle questions (=subject matter) that you were asked?
A: I would say UW was the most high-yield of them all. USMLERx and Kaplan Qbank have been known to test minutiae that are not necessarily high-yield info.
These 3 question banks combined definitely covered more than any one of them
alone. As I mentioned in my post, only 5% of questions on my exam were things I
had never encountered before, so doing tons of questions was certainly helpful
for me.
Q: I am dedicating a solid 8 hours everyday to question banks (I time myself), but
my scores are not improving. What can I do?
A: I would recommend going over the explanations in more detail, making sure
you really understand what the question is asking. Don't skip the explanation for
questions you answered correctly; you can learn a lot by reading about why the
other choices are wrong. It can take a very long time when you first start doing it
this way, but after a while, if you learn from your mistakes, you will not get the
same type of question wrong again. When I first started doing questions, it often
took me 40 minutes to do 50 questions, but an hour to read the explanations and
annotate notes into FA. However, I learned a lot from the explanations in UW,
probably just as much as the questions themselves. It's easy to feel frustrated
when you first start, but with time, I'm sure your accuracy rate will improve.
Good luck.
Q: I am quite frustrated with questions that test minutia details, e.g. "Which of
the following can be found in bacterial endospores?" (Answer is dipicolinic acid) I
had never seen anything like that and I had to flip through pubmed to get the
answer. Are these questions worth remembering?
A: I'm not trying to discourage you here; although dipicolinic acid is probably a
trivia type question, it was actually mentioned twice in FA, so I'd actually still
remember it. Sometimes the strategy is to eliminate the other answer choices if
you couldn't recognize the right answer. For example, if other choices are
peptidoglycan and mycolic acid, you know they just can't be right.
Q: What did you annotate into first aid? Only qbank questions? I find some of the
Micro Qbank questions extremely tedious and testing pHD like material. How
can I tell if its important? Or is it all completely important?

A: I only annotate information that I consider "high-yield". As you do more

questions, you'll soon know what types of questions tend to show up over and
over again; these are the ones that are high-yield.
Take Micro for example, they often give you a clinical presentation of an
infectious disease, then ask you for the most appropriate antibiotics. These
require a two-step process (Presentation - Bug - Antibiotics), and are guaranteed
to be on exam. If they want to be mean, they can ask you about the side effect of
the most common antibiotics used. These questions require a three-step process
(Presentation - Bug - Antibiotics - Side effects), and are less common than the
type of questions above. Things that aid in the laboratory diagnosis or things that
have to do with treatment (for example, HIV gene products and antiviral drugs
that target these products) are also extremely high-yield. Ignore the weird trivia
type of questions that have no clinical correlation.
I agree that Micro Qbank questions can sometimes be a bit annoying, but that
doesn't mean the real exam is like that. I found that FA covers > 90% of the Micro
questions on my exam, so make sure you know FA well and don't get too
discouraged by the low-yield questions.
Q: About doing usmleworld 2X: did you find that helpful even though you already
did the same questions once?
A: I did UW again one month apart. I don't think there's much benefit doing it
again right after you finish it first time through, but a month gives you enough
time to test if you really understand the materials tested, and not because you
memorized the questions and answers. For me, the second time helped me
increase my speed as I was more comfortable dealing with long question stems
(but that could be an effect of having seen the questions before as well).
Q: When should I do UW again?
A: I would recommend doing UW again as close to the exam date as possible,
while still giving yourself enough time to go over FA again and do the rest of the
NBME forms. I went through UW the second time 3 weeks before my exam; I did
350 questions every day to simulate the exam length and build up my stamina.
When I finished, I still had 2 weeks left to review the material that I mentioned
above.
Q: When did you really start feeling comfortable with the material?
A: I probably started feeling comfortable with the material after I finished Kaplan
notes and had done 2000+ questions. By that time, I knew my strengths and
weaknesses and knew what to focus on in order to get the most out of the review
process. For example, after doing some questions, I realized I had a lot of trouble
with neuroanatomy, and so did HY neuroanatomy for 2 weeks, which seemed to
effectively remedy the problem. Besides, as you do more questions, you soon
realize the amount of information that FA actually covers. The questions also
help you remember the material in FA more easily.

Q: Any advice on test-taking strategies?

A: One thing I found really useful from doing tons of questions is that on the real
exam, I could often read the question stem and predict what type of question they
were going to throw at me. I would also recommend coming up with your own
answer in your head before you look at the answer choices; reading the other
answer choices (distractors) before committing to a response can be confusing,
especially when you're not very certain of your answer to start with. Of course, if
you really have no idea what the question is getting at, reading the options first
while using the process of elimination is often helpful.