Amjad Elmashala (Step 1 score 269) — USMLE Experience — The Paradigm Shift Group

Dear Step 1 takers,
 Step 1 score — 269

So many of you have asked for my experience, I’m sorry for the delay as I just had the step 2 CS exam two days ago. I am a recent graduate of Al-Quds University in Palestine, and now an intern. I was confused at the beginning whether to take step 2 CK (like all graduates from my university) or step 1. My friend „Kinana Abu-Rayyan‟ talked to me for hours about the benefits of doing step 1 before step 2, and now I know she is right. She‟s always right hahaha! So, I started my preparation on the 15th of July, 2016, but the real kick in was not until July 30th, when another friend of mine Mohammad Adawi decided to begin preparing for the step 1 as well. I read a lot of experiences to decide how I want to proceed with this, and I saw so many students scoring in the 250s and 260s who have only done UWorld “UW”, First Aid “FA” and Pathoma (UFAP). My target was to get at least 250 in the beginning of my preparation. I started with pathology, since it was the least terrifying to me and I did not want to get disappointed or bored from the very beginning. I watched one chapter of Pathoma videos each day, then I went on to read the same chapter from the book. At the same time, I was doing the UW pathology questions for that particular chapter at night. My friend and I usually then talked at 10 or 11 pm when we were done to discuss some of the questions that were either confusing or that we got wrong, and share our ways of thinking on these particular questions. It was really beneficial to see how he was thinking. This took us about 25 days and anywhere between 5 and 8 hours per day. We were also skimming through FA especially towards the end of the 22 days, but I wouldn’t say that we really studied it. Then we decided to move on to biochemistry, we watched Kaplan 2014 biochemistry videos (44 hours) with Dr. Turco and went through FA. Genetics was explained in the first half of the videos, so we took a couple of days to answer UW questions in Genetics, then we went back to finish the metabolic part and answer all the biochemistry questions from UW. This process took us two weeks. Then we went on to study physiology, we read the BRS and FA at the same time, and answered the UW physiology questions. We needed 10 days to get that done. After that, we started watching Pharmacology videos. I watched Kaplan 2014 videos and my friend watched 2010 videos. The 2010 videos have much more details and I think they are worth doing more than the 2014 videos. We did the pharmacokinetics; pharmacodynamics and autonomic nervous system drugs from Kaplan. We read FA at the same time and answered UW pharmacology questions. We left the antimicrobials until we study microbiology. This took us another 10 days. Then, we studied microbiology and immunology from FA we watched videos only for the antimicrobials from Kaplan 2014, and we were going through the UW questions at the end of each. These two took us two weeks, but we knew that we will have to come back to them many times to master them — so many details. After that, we watched the Kaplan 2014 videos for anatomy and read FA, then went through UW anatomy questions. This is one of the topics that made us suffer all the way during our studying. I still don‟t know what to recommend for you. Anatomy took us 10 days of preparation. Finally, we watched the Kaplan 2014 videos for behavioral science, psychiatry, and biostatistics for the last couple of weeks of our first preparation. They were okay but definitely not enough, especially for international medical students who barely study these topics. We went through UW questions, and they were pretty tough, we didn’t have the right framework for answering the questions correctly. That‟s why in our second time of studying, we read the 100 cases in medical ethics by the amazing Conrad Fischer. It took us one day to finish, which was the day of the Classico. It‟s a very well written book and very easy to understand. So these were the first 3 months, give or take a few days.

At this time, I took NBME 13. I always liked to challenge myself and see how I‟m progressing. My friend didn’t like to do that, so it really depends on what you prefer. I got 17 questions incorrect, but some of the questions were missing. Do not multiply the number of correct questions by 1.3 or 1.4, this really doesn’t help you predict your score. Just know how many questions you got incorrect and learn from your mistakes. The only way to find out is to take an online NBME or to find someone who took the same NBME online and got the same amount mistakes as you did.

From around the 10th of November until the 7th of December, it was time to go through FA from cover to cover one time. Two pieces of advice that I would like to give you here because I noticed them after we were done with the FA. The first one is NEVER EVER leave UW questions or any other questions for a long period. You really lose your sense of reading the questions fast and answering unknown questions to you correctly. The second piece of advice is to do Biochemistry then, for example, Cardiology and Endocrinology, then to go back to Microbiology and then do another 2 chapters from the second half of the book, and so on and so forth. This way you will not be bored by the dry material presented in biochemistry,microbiology, and immunology. During the same period, I watched some of the USMLERx videos, which go through the FA book page by page. The new videos are excellent, and I highly recommend them. They were equivalent to Kaplan videos. Unfortunately, I didn’t have the time to watch all of them. After that, I took NBME 15 and got 250. I was relieved at that moment because I have already reached my target.

On December 9th, we registered for the online UW for a couple of months along with the two self-assessments (which I highly recommend). UW took us 25 days to complete for the second time. During this period, we started taking one NBME each week, so that by the 5th of January,we have done 3 more NBMEs. For the following 2 weeks, my friend Kinana Abu-Rayyan convinced me to start doing NBMEs. Before that, I was planning only on taking 3 or 4 of them. But she has a great spirit. So we started doing 50–100 questions per night, and we would talk for two or even three hours to discuss every single question. At this point, NBME became a learningand not an assessment tool. NBME helps a lot with exposing you to difficult questions that you might have never heard of. It also makes you better at guessing the right answer, even when you have no clue how to get to it. We also did UWorld Self-Assessment (UWSA) 1 and 2 at three weeks and two weeks before the exam respectively. My scores were 274 and 269, and I was on the 96th and 92 nd percentile in each UWSA. I did not care much about the number, but the percentile gave me some reassurance.

My friend and I traveled to Jordan to take the test in Amman on the 30th of January. Our scheduled test was supposed to be on the 1 st of February. On the night before the exam, I didn’t sleep well — I was too nervous. I woke up and got ready for the test. I arrived at the center 45 minutes earlier. This is where I had my bad experience. The people at the center tried to log me in at around 8 am, but the system got stuck, so I had to wait for a whole hour to fix the problem. Then, they tried to log me in again at 9 am, and it didn’t work. All examinees were already in except for me. At 10.20, they came to me and asked me if I want to reschedule my test for another day. I told them “No”, I mean I wanted to be free at the end of the day and just relax. So they tried to log me in another couple of times and didn’t work for reasons that I still don’t know. At 11.40, they told me that, if I want, they can get me another test in 15 minutes. This time I refused, I was so tired of waiting, I had tachycardia for most of the time outside and I
 vomited once. So, I decided not to take the test, go back home and reschedule for the next week. I was depressed for the following three days. I was sleeping for 12 hours at times! My friendstayed with me for that period. I reviewed a little bit of biochemistry and microbiology two days before my rescheduled test. I made sure that I would not get disturbed at that night. I went to bed at 9 and had a wonderful night sleep.

I woke up in the morning refreshed. I packed my snacks and kept on my pajamas, and I headed to the center and hoped not to experience what I experienced 5 days ago. I was not stressed for the second time as the first time. As soon as I began the test, I felt I was back home answering UW questions. The questions were more like UWSA than NBME, and they were long. I didn’t have any problem with time management. I always had at least 15 minutes left to go over questions I flagged. I was able to revise two complete blocks during the test. I decided to take a break after the first two blocks, then the second two blocks, and then after each block till the end of the exam. When I was on break, I was staring outside the windows and smiling :) because first I know that I’m going home today with that burden off my back, and second, the questions I got weren’t extraterrestrial. I got 7–8 questions per block which were difficult and 2–3 which were really challenging.

Materials used during preparation


Pathoma once, UW and FA … and no, I didn’t read Goljan or Robbins


Kaplan videos 2014, UW and FA


Kaplan videos 2014, first 3 chapters of Kaplan book, UW, and FA


BRS physiology, UW, and FA

Microbiology & immunology

UW and FA


Kaplan videos 2014, UW and FA

Behavioral science and biostatistics

Kaplan videos 2014, 100 cases of ethics, UW and FA

National Board Medical Examinations (NBMEs)
 NBME 1 → 14 incorrect questions
 NBME 4 → 10 incorrect questions
 NBME 5 → 12 incorrect questions
 NBME 6 → 10 incorrect questions
 NBME 7 → 17 incorrect questions (9 mistakes in the last block, I was very tired at that moment)
 NBME 11 → 15 incorrect questions
 NBME 12 → 16 incorrect questions
 NBME 13 → 6 incorrect questions
 NBME 15 → 15 incorrect questions
 NBME 16 → 12 incorrect questions
 NBME 17 → 13 incorrect questions
 NBME 18 → 15 incorrect questions, which corresponds to 261 … it was the closest to the real exam and I recommend that you take it last and online.

UWorld Self-Assessments
 For the UW self-assessments, I felt like the exam was more similar to these than the NBMEs as I have stated earlier. When I took these UWSAs, I always woke up early, made myself breakfast and a cup of tea, and tried to simulate the real exam as much as possible.
 UWSA 1 → 274 (96th percentile)
 UWSA 2 → 269 (92nd percentile)

Finally, I would love to take the chance to thank my family, and my friends especially the ones who took the exam in the same time — Mohammad Adawi (259) and Kinana Abu-Rayyan (257) for supporting me all the way through. And for you, my friends, I wish you all the best of luck on your preparations and on your tests.


Amjad Elmashala


It was republished here with permission from the author.

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