Passed with LOW SCORES (Practice NBMEs never broke 65%)
tl;dr - you need approx. 60% to pass. Trust your prep. Getting past the mental block is just as important as studying. Ethics, micro and pharm are easy points.
Hello! I figured I’d give back to this community after getting a pass on Step 1 :) As the title says, my scores were not great but I still passed on the first try. For the students that are trying their best and are plateauing, this one’s for you.
For context, I took 11 weeks to prepare for the exam. I’m a US MD student who is a below average student (not by choice! Everyone is just so smart so I fall under the curve often). Moved my exam twice due to scores not being where I wanted it to be.
Study Resources (tl;dr - use UWorld, sketchy micro/pharm, FA, dirty med, pathoma, randy neil, and mehlman arrows + risk factors)
- UWorld - Gotta use it. I got through 95% of the questions with a 51% correct rate. I would also repeat incorrects on topics I struggled in, such as Cardio and Anatomy. The ethics section was enough ethics prep for me personally
- Sketchy micro/pharm - Finish it, yall. They’re free points! And hammering it into your memory will help with Step 2 and your overall clinical reasoning for clerkships (at least sketchy pharm will)
- First Aid - My Bible. I didn’t read it cover-to-cover. Instead, I used it as a reference for NBME incorrects. If I missed a question on membranous glomerulonephritis, I’d review all nephritic/nephrotic conditions in FA and make cards for them.
- Dirty medicine - Watch his Biochem playlist at 2x speed, do the associated cards. At minimum, watch: Galactose Metabolism, Lysosomal Storage Diseases, and Familial Dyslipidemias.
- Pathoma - Chapters 1–6 are non-negotiable. I annotated the book while watching and reviewed any other chapters I felt shaky on.
- Anki - I used a self-made deck for UWorld screenshots (especially tables) and high-yield FA diagrams (lymph drainage, embryology).
- Mehlman - I do not like that man (if you know, you know), but his arrows are a great way to consolidate high yield physiology and pathophysiology. Thanks to him, I will never miss a Cushings-endocrine question ever again. Risk factors pdf good
- Randy Neil - biostats, you know the deal
Exam Scores:
NBME 29 - 48%
NBME 32 - 50%
Two percent increase after two weeks of studying stung. Spent the next week focusing primarily on sketchy micro and pharm
NBME 28 - 59% (one week after NBME 32)
NBME 31 - 60%
NBME 33 - 56% (Taken under poor conditions—construction noise all day at the library.)
Scoring the 56% shattered me. At that point, I had done all of sketchy micro/pharm, and 75%+ of UWorld. I felt completely worthless. And then I reviewed the exam. It was littered with silly mistakes. I then realized that I absolutely knew this content, I was just second guessing myself. The next two days, I went deep into NBME incorrect review. I got a journal and made it my “incorrect,” journal. I would write out my incorrect questions and expand on the topic. I would reread it every night until the real exam
NBME 30 - 64% (90% chance of passing; taken two days after NBME 33)
For this exam, I took my time with every question. For each question, I tasked myself with mentally explaining why I chose that answer. Which part of the stem points to the answer? If I couldn’t confidently pick, I’d flag and move on.
NBME 26 - 59% (ten days before real-deal)
Free 120 - 66% (three days before real-deal)
Exam Day:
First thing I wrote on my whiteboard?
“You know the content. You know the answer. You’ll pass”
The self-motivation wasn’t enough because girl, that exam was so HARD. Felt most similar to free120 and NBME 31. I flagged about 15 questions per block, sometimes more. Very heavy in ethics, microbio, niche embryology and VERY TRICKY BIOSTATS. RANDY NEIL HIMSELF COULDN’T HAVE PREPARED ME FOR IT. I had one MSK question, no NBME repeats…no sensitivity, no specificity, it was ridiculous. There were a lot of gimme questions too which was nice. Plus, zero biochem which was great for me (hate biochem)! Otherwise, even though the exam felt brutal and felt like I was guessing for half of the questions, I was quite calm. I only lost my cool around the end of the last block when I realized I might’ve failed. When I left the exam, I proceeded to cry in my car.
The next two weeks were so anxiety inducing, which is commonplace for nearly all students. I was severely depressed because of it all. I was convinced I failed and proceeded to continue my Step 1 Anki, preparing for a retake. When I opened my results that morning, I couldn’t believe it.
Couple of tips!
- Trust yourself. I knew that I understood the material to pass; I just had to get past the mental block.
- If your scores start to drop even with thorough review, take a break. Signs of burnout can be insidious
- If you see a very hard question on the real deal, flag and move on. Likely experimental
- Thoroughly review your incorrects from your NBME exams
- Eat well, move your body, call your friends and family
- Take the practice NBMEs in ascending order.
- I should’ve started Sketchy micro/pharm before dedicated
Final thoughts:
For the folks frantically searching through this subreddit after taking Step 1 with low scores, you are seen, and your anxiety is so so valid. I did the same thing while waiting for my score. Here’s a reality check. To pass Step 1, you need approx. 60% to pass. This isn’t a hard cut-off! This means a person with an easier exam (ex: an exam with many many repeated questions from old forms) might need a 62% to pass. Compare that to a guy with a much harder form; they might need a 58% to pass. This all could be me coping, since no one really knows how the sausage is made. But personally, if there was a hard-cut off for this exam, I feel like USMLE would explicitly say you need at least a 60% to pass.
Yes, the exam is hard. But I do think that despite the hard questions, you will pass if you’re earnest with your prep.
Message me if you need any help :)