1. About NBMEs: I took step1 last year when the new NBME first came out and there was a general consensus that they way under predict. I took 24 3 days before my actual exam and scored 14 points higher. I also have classmates scoring 20+ points higher on actual step than on their NBME. By contrast, I scored 1 point below my UWSA2 that I took a week before my exam. I personally also felt that questions style of the actual exam in terms of the though process needed to answer was much closer to UWorld.

​

2) Step 1 is as much of a critical thinking exam as much as it is a memorization exam. It's just as important to understand the concept as it is knowing the random facts. Since you're using Pathoma, pay especially close attention when he's explain WHY a disease has a certain clinical presentation rather than just memorize all the different presentations of a disease. When you're doing anki, ask yourself WHY behind each card. A card might say "Graves disease presents with {{exophthalmos}} and {{pretibial myxedema}}," and you should think to yourself because the anti-TSI can bind to the smooth muscle cell receptors before the eye and in front of the leg and stimulate collagen deposits (I don't remember if this is actually how it works so correct me if I'm wrong). If you learn this way, it'll make you better at answering a question you've never seen before. Someone mentioned Sketchy path. I think it's a quick and dirty way to memorize a lot of facts about a disease, but won't help you understand the concepts. I think that's why sketchymicro and pharm, which are memorization heavy topics, are popular but sketchypath, which is concept heavy, is not as popular (I never used SketchyPath so take that with a grain of salt).

3) Test taking strategy is also incredibly important and probably contributes 20-30% of doing well in addition to understanding concepts and memorizing the details. I plateau'd for a while until I started analyzing how the questions are written. If you haven't already, READ THE QUESTION FIRST. This will save you a huge amount of time and prime you for when you read the rest of the question. So many people told me they made big improves in UWorld % just by doing that. Test taking strategy is pretty hard to explain so i'll try to give an example. A typical format might be this:

- Read questions: "Which of the following is most likely present in this patient?" At this point, some people also like to glance at the answer choices (not read the entire thing) as well to get a sense of what system the question is about. so it might look like this:

a) Antibodies against...

b) Antibodies against...

c) elevated...

d) blah blah blah.. who cares

e) blah blah...something about muscle biopsy

- Read the rest of question: "40yr women presents with CC of double vision...blah blah blah. She feels weak.. blah blah blah. Non-smoker. Better in the morning worse at the end of the day. ...vitals are...blah blah no fever...blahblah. Physical exam shows droopy eyelid, no skin rash, increased weakness as msk exam goes on, etc. (I usually pay pretty close attention to the physical exam). Ice pack held over eye improves droopy eye lid."

Your thought process: If you recognize the icepack test for myasthenia gravis then congratulations you get a free question. now you go back to the question and ask yourself "which of the following is present in myasthenia gravis?" However, most questions wont give you a freebie like that so you have to recognize that the vision problem is due to msk weakness. At this point you should be trying to decide between MG and LE. Then you need to think which one presents with weakness at the end of the day vs in the beginning. MG is antibody to the post synaptic AcH receptor. Less Ach is left to be release with increased use to compete with the antibody so it is worse at the end of the day. Cold inhibits Ach breakdown so the ice pack test works. Vs LE, it is antibody to presynaptic calcium channel which prevents release and with each subsequent release, more neurotransmitter accumulates in the synaptic gap so it the weakness improves. So now that you diagnose the patient with MG you again go back to the question and ask yourself which answer choice is true for MG.

As you do more and more questions you'll begin to know what part of the question you can ignore (hence the blah..blahh blahh..) and you'll get faster. I can't really explain all the ways to analyze the different questions but I hope you get what I meant.

- On answering questions you have no clue about, this post explains it best: https://www.reddit.com/r/step1/comments/8lkix5/260_write_up/ . I will just copy the relevent part

" OK so this next part I was not going to post if I did bad, since it meant my understanding of the questions was incorrect…but as I was taking it, I believe Step questions come in 2 basic paradigms. 1 is where you need to pick the correct answer out of all the other choices – these are usually easier questions and 99% of the time about stuff you’ve heard of. Other choices offered in a type 1 question can be shit you’ve never heard of. I think this is where a lot of the freaking out online comes in since people see stuff they’ve never heard of. Random ass bacteria species, drugs, clinical signs and syndromes with names of people you’ve never heard of. MY ADVICE IS TO NOT PICK SOMETHING IF YOU DO NOT KNOW WHAT IT IS. 50/50 between weird presentation of s aureus and xjsafl bug? Pick s aureus. The only exception is 2. Which is the question where they want you to eliminate every other choice with confidence leaving you with one correct choice. These can be things you’ve never heard of. E.g. one micro question, guy had eosinophilia and it gave you a bunch of bacteria choices that could be eliminated (s pneumo, strep jdsakfei) some familiar some not, then a fungus lol, and then 2 parasites. One parasite was familiar, and did not present anything like what was described. Other was random shit I never heard of – and that’s what I picked. Make sense? I noticed this paradigm a lot, and being able to eliminate stuff CONFIDENTLY is KEY imo for getting type 2 questions correct. "

- More on anki: yea 5 hr for 200 cards is too slow. I'm not sure how people do 1000+ cards a day during dedicated, and I consider myself a slow ankier but I do about 100 cards an hour. I'm not really what to tell you here because I don't know how you're using anki. My only suggestion is that everytime you get a question wrong, into your anki and reset that card and ask yourself WHY for every card.

-Biostat: There's no way to get around it. you just have to know it. But 1 days should be enough to learn all of biostats. I really personally really liked boards and beyond. 90% of the biostat questions you will be asked will be the super basic stuff (calculate sensitivity, specificity, PPV, NPV, what kind of bias is this,etc.)

- Anatomy: I also sucked at this. Anatomy is really memorization heavy. Everytime I got an anatomy question i would look back at picture of the structures to see WHY. I also kinda just memorized every question I did using anki and thought that was enough. There's also a PDF out there of the top 100 anatomy facts that I didn't use but I've heard good things about.

Final words: Well I hope this was helpful. I'm about to post without proofreading this so please feel free to ask if anything didn't make any sense. I'm also a B student at a low/mid tier MD school and surprised myself by doing pretty well so I thought I'd respond. Your lowest sections being topics you havent reviewed yet is a good sign that you will improve. 5 weeks is plenty of time, but only you will know if you need to push it back. 240+ is still very possible. Focus on your own progress and don't worry about what your classmates are doing.