Passed Step 1 as an Underdog
Just want to share my underdog experience of passing Step 1. I’m a pretty mediocre USMD tbh, not the worst, but absolutely nowhere near the best. Hopefully this can serve as encouragement (and maybe kind of a lesson) to those who are deep in Dedicated right now.
I started studying for Step during Thanksgiving break, and honestly my in-house grades thereafter suffered because of it. I truly gave it everything I had and studied literally every single day up until my exam day, which unfortunately was only 4 days before my first rotation. I never got the “ideal” NBME scores (2 consecutive 70s), and honestly I was far from that.
By the end, I was borderline burnt out, so I decided to just pull the trigger and take it. I seriously considered delaying even on the morning of the exam, or even taking a whole year off just to study for Step. But thankfully I still went and sat for it.
When I walked out of the exam, I was dead sure I failed. Even this morning while opening NBME for my score report, I still felt the same way. My heart rate was probably over 120 when I clicked open. Thank God it was a pass.
CBSSA 26: 47% (mid Feb)
CBSSA 27: 48% (early March)
CBSSA 33: 59% (mid April)
Step 1: PASS (late April)
Yes, I only had time to finish 3 CBSSAs, and it took me more than 2 weeks just to review one. But I reviewed them very deeply. I finished 75% of UWorld twice -- first while studying block by block alongside our school curriculum, and second time during dedicated.
By “review deeply,” I mean cross-checking notes I had made, continuing to build those notes, watching videos from Bootcamp and UWorld, and using ChatGPT to help identify buzzwords and streamline my flow of thought for differentials.
I talked with our school’s test advisor after the exam, and she said I was taking a huge risk and that she would have told me to delay. She honestly had a point. But at the same time, I felt like I truly had done everything I possibly could already.
I genuinely did not take a single full day off from Thanksgiving until late April. During the second half of dedicated, I was doing and reviewing around 100 UWorld questions a day. So realistically, I think I would have burnt out pretty badly if I had delayed until MS4 to take Step 1. In a way, I’m actually grateful I didn’t talk to the advisor before the exam.
UWorld is hands-down gold for Step. Even now, doing UWorld for Step 2, I’m learning so much from it that directly helps on rotations. For Step 1 specifically, UWorld really taught me how to think through differentials and connect dots between concepts I never thought were related. The more questions I did, the more all the old and new knowledge started forming an interconnected network in my head, where I could start from a lab value, think through symptoms, build differentials, and then figure out what the question was actually asking. UWorld constantly pushed me to think 1–2 steps ahead and connect concepts together.
I used Bootcamp for most of my content review, along with Sketchy Micro and Pharm. Sketchy Micro was holy grail, and I highly recommend it as well. Sketchy Pharm was good too, but honestly way too long, so during Dedicated I mostly relied on my own notes instead. I’m not sure if I can wholeheartedly endorse Bootcamp. The content is solid and easy to understand, but it’s also very long. Looking back, I think I spent too much time watching Bootcamp and therefore didn’t leave myself enough time for CBSSAs. If there’s one thing I wish I had done differently, it would probably be spending less time on passive content review and more time on CBSSAs.
Most importantly, even though my last CBSSA before the exam was only a 59%, I still felt confident in my foundations. After thoroughly reviewing 33, I realized a huge reason I underperformed was because I overthought so many questions. I missed heart murmurs, oncology tests, and other “easy points” because I changed correct answers to wrong ones after overanalyzing.
I completely understand that my approach was risky, and this post would read very differently if I had failed. But I still think it’s worth sharing.
In a nutshell:
- Start UWorld early and review it deeply.
- Use Sketchy for Micro.
- Leave more time to CBSSAs, not passive content review.
- Make your own decision about when to take the exam, because you know yourself best.
PS: I personally felt the CBSSAs and UWorld were pretty representative of the real deal overall. HOWEVER, my exam had a TON of insanely long patient report questions, probably like 1 in every 5 questions. Some were so long I had to scroll 4 to 5 times just to reach the bottom. I personally didn’t see any questions like that on the 3 CBSSAs or UWorld. Some classmates told me Free 120 had one and Amboss had some, but I can’t personally vouch for that.