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  #1  
Old 11-17-2018
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Ireland IMG: 11 YEARS POST GRADUATION: STEP 1: 210 My JOURNEY

Hi everyone, just wanted to post my step 1 experience as an international graduate from Ireland. I hope this will be helpful for international medical graduates as well as old medical graduates who wish to follow a similar path.

Background:
Graduated in 2007 in Ireland. Completed psychiatry residency in London, UK in 2015 with MRCPsych qualification. Started studying full time in 2017 for USMLE's. Overall aim is to practice psychiatry in the States.

Duration of study:
21 months: studying on average 5 hours daily full-time.
It took me 9 months to complete Kaplan package once and first aid at least twice.

Study materials:
Kaplan online videos
Kaplan books
First aid: reviewed 6 times in total
Kaplan q bank- 1 pass
U- world q bank- 3 passes
NBME's online
2 U world stimulation tests.
2 Kaplan full length stimulation tests.

Experience with Kaplan:
I decided to use Kaplan as I was over 10 years post graduation and needed to go back to basics again. The USMLE forum polls suggested that Kaplan was the top source. As well at the time, I was very enthusiastic to give it my best shot.

Anatomy:
I initially went through the videos but found it was repetitive of the book, so just stuck with reading the book. Not sure if BRS Anatomy would have been better.

Behavioural science:
Did the videos and the book. Straight and to the point. I felt that first aid and U WORLD was enough. More challenging questions on ethics/psychiatry in Kaplan Q bank. Embarrassed to say I got some psychiatry questions wrong in Kaplan as they were tricky questions!

Biochemistry:
I did the book and videos. Video's helped me motivate myself for biochemistry and with lots of coffee!. I hated biochemistry in medical school and the videos helped me go through the pathways rather that doing the book alone. Quite detailed for biochemistry but had everything one needed to know.

Genetics:
Used the book and video for understanding. U WORLD helped to grasp questions better.

Pathology:
I didn't use videos for pathology as I felt it was repetition. I read the book. I found it helpful. However I can't compare it to Pathoma or other well known pathology books. But I felt the book was concise to the point.

Immunology:
I needed to use the videos to help me study immunology as I found it a tough subject. In my medical school, it was taught in the final medical school year in about 7/8 lectures. Overall I felt that repetition with first aid/U WORLD was sufficient.

Microbiology:
The videos for this subject was the best in the package as the lecturer was entertaining and used props to help you be engaged and study. I actually enjoyed learning microbiology the most out of all the subjects. She was the best. I felt the book was good as well. First aid helped to condense what I learned in Kaplan. U WORLD helped to practice answering questions better. Kaplan question banks were too obscure.

Pharmacology:
I just did the book as I was getting tired of videos. I felt that kaplan pharmacology was overkill. First aid and u world was enough to cover pharmacology.

Physiology:
I stuck with the book. It was fine. Though I'm not sure if BRS Physiology would have been better. First aid and U WORLD helped to answer diagram questions. Kaplan q banks were tough questions.

I completed Kaplan and 2 passes of first aid in 9 months.
1st NBME 13: 150- devastated after all this study, but I kept preservering.

I decided to do Kaplan Q bank. I felt like giving up after two weeks as the questions were extremely tough, but since I paid for it, I persisted. Overall my average score was 57%

I did 2 nbme's in between;
NBME 15: 171
NBME 16: 175

Slight improvement- kept me motivated to continue.

NBME 17: 186 done after completed q bank. I was beginning to have some hope of reaching the 194 pass mark.

I reviewed first aid one more time.

NBME 18: 175- really disappointed that score was dropping

I decided to do one pass of U world as I had only one NBME left. I also did another pass of First aid. After 1 pass of U world, I did last NBME.

NBME 19: 175- again disappointed. I realised the way I was studying was not working. I spoke with a Kaplan advisor and medical advisor about how unhappy I was with my progress. They wanted me to go over to the States and do a 6 month review course. To be honest, at this stage I felt i had wasted money on Kaplan and to do a kaplan review course would be flogging a dead horse. I just felt they were only interested in money and I didn't pursue it. I knew if I sat the exam I would fail it. I failed all the NBME's. The 2 kaplan stimulation tests, I scored 67 and 68%, but the NBME's didn't correlate. I felt that the NBME curve was so steep, that if you got a set number of questions wrong, you failed outright.

I decided to do a short review course, six week course as at this stage, I was fed of the prospect of studying longer than this. I did a review course course in Atlanta in order to grasp the concepts better. It was a good course, especially listening to someone who has passed the USMLE exams. During the course, I went through all my wrong answers in U world and reviewed first aid again. The course was 4 hours in the morning with a 5/10 minute break in between. At the beginning, I felt it was too short but it helped to build indurance for the real exam. After morning classes, I spent 2 hours going over U WORLD and 2 hours going through morning class notes. After completing the course, I spent 1 week travelling to Arizona to see the meteorite crater but in between reviewed all my NBME'S for a week. I didn't want to spend all my time in America just studying!

I came back to London with a plan to study 3 and a half weeks, 9- 10 hours daily, doing a 3rd pass of U world, as well as going through first aid and notes. I was sitting the exam regardless as I needed an end point.

Prior to the schedule, I sat U WORLD stimulation test 1: scored 209. I was delighted but still a bit weary of the result as I heard that U world overpredicts your score.

I got up every morning at 6am with gym and eating/TV only being my breaks for three and a half weeks. I told friends I could meet up only after the exam. I lived like a hermit for those three weeks lol! Towards the end I felt so sick of studying. I took the U world stimulation test 2, the day before the exam. I score a 213! It wasn't a significant increase but I was confident in giving all my best in the exam.

Night before the exam:
I couldn't sleep properly. I had got sleeping tablets from the GP months before but forgot to trial them out before the exam and I didn't want to risk being groggy the day of exam. I slept intermittently, 3 hours on and off. All that was running through my mind was I studied for over 20 months for this exam and I didn't want to fail it. I woke up in the morning around 5am to review wrong answers on my ;last stimulation test.

Day of exam:
I arrived at 7:30am but the doorman wouldn't let me in as he said the prometric staff don't arrive at 8am. So I spent half an hour drinking coffee and eating two cupcakes at the tube station to keep me alert for the first two blocks. There was so many people queuing for different exams at the London Prometric Centre. There were 15 people before me at 8:00am in the morning. My exam was 8:30am. I was panicking a little that I'd be late but I was checked in for 8:20am. I was made priority for my exam time and ushered before everybody else. I was the only one doing the USMLE exam that day.

My strategy for the exam was no break for the first two blocks and then a 10 minute break on the hour for every block thereafter. I felt it was really important to do a mock exam at the centre your're planning to sit the USMLE, in order to get used of the software and to know where the toilets/lockers are. It helps alleviate anxiety as it's not you're first time there. The ten minute break helped as the men's toilets were two floors down from the exam room, while the female toilets were just opposite the exam room. I thought that was a bit sexist, lol !

Anyway. I brought along with me paracetamol and eye drops, a flask of coffee, chocolate, salads and bananas. I needed the 10 minute break, 5 mins would have not been enough. As during some of the breaks, there were at least three people before me being scanned on the way out/in which used up 5 minutes. My remaining 5 minutes were quickly running down two floors of stairs to go to the toilet, put eye drops in my eyes and I had to take pain killers for a headache after 2 blocks which was a life saver. Then it was like a quick food binge and a gulp of coffee to keep me alert for the next block. It was like that for 2 breaks, the rest a bit more relaxed as there were fewer people checking in/out. I wore tracksuit bottoms to cut down the time checking pockets lol! I couldn't find any pocketless pants/ tracksuits on amazon! Let me know if you know any brands cause I'll wear them for step 2.

Reflection on completing exam:
It is an odd feeling, because I didn't know if I passed or failed it. I had about 7 minutes spared for each block to review marked questions overall. My exam was easier than kaplan and NBME's. It actually felt similar to the U world assessment tests. I thought if I passed it was a borderline pass. I felt a bit down after the exam. Over the next few days, questions of exam day return to your mind and you start checking the answers. I checked two answers and got them wrong, making things worse! I decided I had to be preoccupied. I cleaned my room, and three weeks of laundry. I went home for a week and went on holidays for a few days. However the exam results are always at the back of my mind. You are not a 100% relaxed. One day I even prepared a timetable for repeating the exam to lessen the blow if I failed. You are in a state of limbo because if you started again to study to repeat and you pass, you wasted three weeks, likewise if you started studying for step 2 and end up failing it. I was so used of studying by now, it felt really odd not having a routine. There were times during my step 1 study period when I didn't feel like studying and doing fun things but when I had the time off after the exam, and plenty of time to do fun things, it didn't feel the same until results time.

D- DAY:
I got the email on the Wednesday after 12:30pm saying that results are on OASIS. My heart started pounding rapidly. The results wouldn't open the first time, then it opened the second time. My eyes were just looking for pass/fail. I saw a PASS, initially I thought that was just an explanation for everybody if they passed. I was disorientated a bit as I was filled with anxiety. Then, I looked up and saw s score of 210. I burst into tears with relief. I passed!

I'm happy with the score. I wish maybe I got a 220-230 but overall I'm really happy I passed on first attempt. Even though my score is below the mean average for psychiatry applicants, I'm hoping my psychiatry experience will help

Overall reflection on USMLE study journey:

If I were starting all over again, I wouldn't have used Kaplan. I felt it had too much detail. I would have used some of their books in conjunction with perhaps BRS Books, but I don't have experience on this. I probably would have reduced my theory learning to 6 months. I might have tried SMASH USMLE instead but I wouldn't know if I'd had got a higher score. I don't regret doing U world three times, it helped a lot. Kaplan Q bank was too obscure, though some few questions on the real exam had mirrored Kaplan. I don't know if it would have been better to have done USMLE rx instead. Again someone reading this will have praise for Kaplan and got a high score but everyone'S experience will be different for any study materials and every student/doctor will have a slightly different aptitude. I'm happy to answer some queries!
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  #2  
Old 11-17-2018
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congrats kieran ...its a inspiring journey..all the best for step2
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  #3  
Old 11-17-2018
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going to start NBME in couple of weeks ...its irritating to sit for long time everyday n study ..how did u overcome this??
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  #4  
Old 11-18-2018
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Hi Chandum, thanks. I'm not a morning person but I treated studying as if it was a job. I used to get up around 6/7am and eat. I would study for about three hours. I would then go off to the gym and eat after. i didn't want to spend all of my time in the room at home. I actually felt refreshed after exercise. i was recharged to study again, taking an hour break after two hours and built my stamina gradually. You need to have a balance. I usually met up with friends or went out during the weekends as it gave me something to look forward to. If you just study with nothing to look forward to end of the week, you'll get fed up of study. I kept in contact with doctors I worked with so to lessen to social isolation.
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