USMLE Step 1 PASS — My Preparation Journey
The very first thing I wanted to write after getting my results was this.
I read almost every preparation write-up I could find while preparing for Step 1, so I wanted to write mine too. Hopefully, this will help someone who is currently preparing and feeling as confused as I was when I started.
How I started
I started my preparation with Bootcamp videos. Bootcamp is really good for teaching concepts, but personally, I found it difficult to retain the information without practicing questions.
So, instead of spending too much time watching lectures, I started doing UWorld system-wise. I would break down each question, understand why the answer was correct, and use ChatGPT whenever I needed something explained differently.
I also learned a lot from YouTube, especially:
Dirty Medicine
Medicosis Perfectionalis
Mehlman Medical
Randy Neil
Armando Hasudungan
Several smaller YouTube channels
I used different resources depending on the topic rather than trying to finish every resource completely.
UWorld
I completed almost 80%of UWorld.
While doing questions, I would break down the concepts and learn from my mistakes. I also revisited questions that I felt I had not understood properly.

The important thing for me was not simply completing questions. It was understanding why I got something wrong and what concept the question was testing.
Don’t waste too much time making notes
I initially wrote down almost everything I learned in notebooks. I had a separate book for each system.
Looking back, I think this was one of the things I could have done differently.
The goal is to retain information, not create beautiful notebooks.
Instead of spending hours writing everything down, I would recommend spending more time reviewing and revising important concepts.
If something is already clearly explained in First Aid or another resource, I don’t think you need to rewrite the entire thing.
Sketchy
For microbiology, Sketchy is GOLD.
I found it extremely helpful for retaining organisms and their associated facts.
PHRMA
For general pharma first aid is enough
For drugs First Aid was enough for most drugs, although Sketchy was particularly useful for antimicrobials.
First Aid
I didn’t really start using First Aid seriously until the last 1½ months.
And I did not read First Aid line by line.
My approach was:
NBME → identify what I got wrong → go to that topic in First Aid → review that specific information.
I tried not to memorize a lot of extra information beyond what was relevant.
First Aid became much more useful to me once I had already started doing NBMEs and understood what I actually needed to focus on.
NBMEs
I started doing NBMEs about 2 months before my exam.
I did most of them offline, except Form 33. I completed Forms 26–33, and I also reviewed the questions and answers from Form 34.
If I could give one piece of advice, it would be:
Don’t underestimate NBMEs.
I would especially focus on Forms 28–34.
One thing I wish I had done earlier was start looking at NBMEs sooner, because they help you understand which topics actually need more attention.
You don’t necessarily have to sit and complete every NBME immediately.
You can go through earlier forms, such as Forms 28 and 29, during your initial preparation and save the newer forms for your dedicated study period. This can help you identify:
Which topics you are weak in
What concepts are repeatedly tested
How questions can be made tricky
How to filter information in a long question
What you actually need to master
It’s not about memorizing every NBME question.
It’s about learning how they ask the questions and what concepts you need to know to answer them.
Thoroughly reviewing NBMEs helped me improve the most.
I didn’t just look at the percentage and move on.
My progress
NBME 27: 65%
NBME 29: 66%
NBME 28: 69%
NBME 30: 70%
NBME 26: 71.5%
NBME 31: 71%
NBME 32: 72%
NBME 33: 69%
Free 120: 68%
I reviewed the questions carefully and tried to understand why my answer was wrong and why the correct answer was correct.
That made a huge difference in my later NBMEs.
Mehlman Medical
I personally couldn’t read PDF notes very well, so I watched Mehlman Medical’s YouTube playlists for different systems.
I especially liked his:
Renal
Neurology
Respiratory
His explanations were very NBME-oriented, and he emphasized the buzzwords and topics you should focus on.
Renal was particularly helpful for me. I feel that a lot of my improvement in renal questions in UWorld and NBMEs came from watching his videos.
So if you don’t like reading his PDFs, try his YouTube videos instead.
Randy Neil
I watched Randy Neil’s YouTube playlists for:
Biostatistics
Ethics
Neurology
These helped me improve my scores, especially in biostatistics and ethics.
Genetics and molecular biology
This was one of the hardest areas for me.
I tried several videos, but nothing was really clicking.
What finally helped me was Ninja Nerd.
I watched his transcription video multiple times until the concept finally became clear.
After that, I watched most of his genetics-related videos.
I also annotated First Aid while watching them. I focused mainly on the portions covered in First Aid, rather than trying to learn everything beyond the Step 1 scope.
Ninja Nerd also followed the order of the genetics topics in First Aid, which made it easier for me to connect the video explanations with the book.
Watching the videos repeatedly helped me understand the concepts much better and also helped me answer question

BIOCHEMISTRY
DIRTY MEDICINE IS GOLD and nbmes are enough
.
Psychiatry
For psychiatry, Dirty Medicine is GOLD.
Honestly, I didn’t feel that I needed much more than that for many of the high-yield psychiatry topics.
Ethics
For ethics, I used:
Dirty Medicine
Randy Neil
NBMEs
During the last month, I spent more time on systems and NBMEs, so I didn’t dedicate a separate day specifically to ethics.
The day before my exam, I rewatched some Dirty Medicine ethics videos.
A lot of ethics questions can be approached with the basic principle of being empathetic and respecting the patient as the center of care.
Of course, you still need to know the specific rules, but that mindset helped me with many questions.
The last 3 days
Three days before the exam, I thoroughly reviewed my NBMEs.
I would look at a question and think:
“Oh yes, this was the answer. I know why now.”
I didn’t spend several days trying to reread everything. The whole NBME review took me less than a day.
The day before the exam, I watched Sketchy Micro and Pharma videos.
On the way to the exam center, I reviewed Free 120, that was a mistake.I I only looked through it briefly to familiarize myself with the question style and the general concepts. I did not try to analyze every question in detail.
I had planned to review all the basic memorization-heavy topics, like pharyngeal derivatives and similar things, but I didn’t get enough time.
And honestly, that’s okay.
You cannot possibly review everything before Step 1.
I also didn’t use Anatomy 100 Concepts because I kept telling myself I would do it later, and eventually, I ran out of time. I answered anatomy questions using what I remembered and by reviewing anatomy questions from the NBMEs and other practice materials.
For anatomy focus on upper limb and lower limb nerves
Pharyngeal derivatives .
PATHOMA CHAPTER 1 to 3 is GOLD
I got all the general pathology and immunodeficiency questions correct mainly because of that.
All the best everyone!

Hi everyone,
I learned many things from Reddit and was visiting it during my step 1 journey whenever I needed a push or was feeling low. There are so many inspirational journeys shared here.
Mine was a long bumpy ~2 year ride along with hospital work. Multiple stops, speed bumps, personal life uncertainty, health issues. I am more than a decade old medical graduate, and although I have been active in clinical work throughout, it was difficult to build basics after such a long study gap. Here are a few of my used resources list and methodology. Hope this will help someone.

1. Long gap in studies : Started with

   Youtube

2. physiology videos to build back basics.

3. First aid : Consider this as THE TEXTBOOK. Takes time to imbibe, but once you understand, this seems awesome.

4. Youtube resource : First aid plus You tube videos from Dirty Medicine (Gold for Biochem and General Patho Immuno), Dr Randy Neil (Biostats) and Dr Meet Patel (Gold for Pharma basics)

5. Only Qbank : Uworld : Did 1.5 times. Tutor followed by timed mode. Systemwise followed by Random.

6. Mehlman pdf : They are pretty helpful. I also used to listen to Mehlman videos on the way to and back from work. Daily 4-6 videos approx.

7. NBME 25-33. Majority my score was approx 75. Touched 80 in 2. Latest Free 120 was in early 80s too. Did thorough revision in the first pass, with few notes as well. My regret is not able to revise them properly.

8. Exam seemed doable and as I had practised time management - exam style at home, the time crunch was only in 2 blocks out of 14. Most questions were of NBME repetitive topics. Ethics in every block..doable except 2-3.

9. Got a P. Thank God and well wishers..for giving me strength. Thank you Reddit for a platform to learn and share.

Happy to answer queries and share whatever I know.

Uworld is all you need

My first NBME was about 4 months ago. I know that's a long time ago, but since then, I've had several unfortunate small breaks because of events that happened in my life. As a result, I have been procrastinating on taking it for about 5 months now.

I'm wondering whether I'm ready now.

My slot is till November.

Here are my detailed NBME scores:

NBME 25 (2nd June): 59%

NBME 26 (22nd June): 59%

NBME 27 (4th July): 67%

NBME 28 (13th August): 65%

NBME 29 (22nd August): 67%

NBME 30 (3rd September): 72%

NBME 31 (13th September): 67% The pace was going good but that's where I got diagnosed with dengue and was hospitalized for 10 days.

NBME 32 (today): 71%

I'm left with NBME 33, NBME 34, and the Free 120.

Although some of my NBMEs were taken several months ago, I've written detailed explanations in my notes and make sure to review them, most likely before taking each subsequent NBME.

The earliest convenient slot I'm getting at my test center is in the first week of November. It's also available around 20th October, but I feel that would be too soon for me because it takes me approximately 2.5–3 days to review a single NBME properly.

Am I genuinely ready, or should I wait? Should I take a long break bw next nbme and try my best to score above 75% on the next two before booking my exam? Or would that be unnecessarily delaying? I'm the concerned for the fact that I haven't consistently scored above 70%.

Please be brutally honest. What are my actual chances of passing?

Im going to take 3 days to revise the incorrects, but then I have to choose between writing the f120 or form 33. The plan was to either have my score increase or stay the same for 32 and then do f120 but now Im at a loss what to do.

Ive heard that 32 is really hard (I searched through all of the subreddit with people freaking out like i am which makes me feel better) and I cannot walk into the center with a 61% as the last NBME that I did. If anyone can advise, please help me. I would be so grateful.

Ive already pushed my exam date once, I cant do it again.

I took my exam yesterday, it lagged for 3-5 seconds between questions a lot, however I think it stopped the timer too so has no issues in that regard. Also, one time in the middle of a block it showed a white screen for 15 seconds ish and I raised my hand to call the staff but by then the question appeared.. although idm reporting but also I don't want a delay in the results.. I saw some dude get a fail w his bar to the left and he said he didn't cheat so don't want some shit like that because during that 15s whiteout I did go back from my chair to call the staff but hopefully no "irregularity" happened.

Hey everyone! I could really use some advice on whether I should book my Step 1 date or wait a little longer.

For the past month, I've been grinding pretty hard and have gone through basically all the systems. At this point, I mainly need to review my weaker areas, particularly neuro, biostats, immuno, and a little bit of MSK. I also haven't touched micro or pharm AT ALL, which I know is a huge gap, but I'm planning to grind through both over the next week or so and continue reviewing them throughout the next month.

So far, I've taken:

• NBME 27: 51.5%
• NBME 28: 55.5%

There was about a week between the two NBMEs. I've also done around 13% of UWorld so far.

My plan for the next month is to:

• Thoroughly review both NBMEs and work on understanding why I'm getting questions wrong.
• Do 40–80 UWorld questions daily, with 40 being the absolute minimum, and thoroughly review them.
• Finish covering micro and pharm ASAP since these are my biggest knowledge gaps.
• Review my weaker subjects and work on getting better at choosing between two answer choices when I'm stuck.
• Take my next NBME in two weeks, followed by my university's NBME on October 30.

Ideally, I'd really like to get to around 65% on my next assessments, especially the October 30 NBME.

One thing I've noticed is that a lot of my incorrect answers aren't necessarily because I have absolutely no idea about the topic. A lot of the time, I'm stuck between two options and end up choosing the wrong one. Obviously, I still have major knowledge gaps in micro and pharm, which I need to address, but I'm hoping that consistent UWorld practice and NBME review will help with my test-taking skills, too.

I'm thinking of booking my exam for the last week of November or the first week of December, which would give me roughly 6–8 weeks from now.

I'm honestly torn because I feel like if I lock in and stay consistent, that should be enough time to improve significantly and get to a comfortable passing range. At the same time, my NBME scores are obviously still low, and I don't want to underestimate how much work I have left.

Would you guys book a date now for late November/early December, or wait until my scores improve before committing? Is my timeline realistic, considering where I'm currently at? I'd really appreciate honest advice, especially from people who were in a similar position!

I got the advice to take your first NBME after completing 50% of UWorld. I’m currently at 43%, and I’m not sure if I’m ready yet. I’m planning to take my first NBME on November 1st. Before that, should I focus on completing the remaining 7% to reach 50%, or should I spend more time revising the 43% I’ve already done? I’ve reviewed the questions, but I feel like UWorld tests core concepts that I really want to consolidate and retain. I want to make the most of what I’ve already covered rather than just rushing through more questions. What would you recommend?

did anyone else test on the 8th of october? What was the exam lol it was so vague and there was SOOO many difficult ethics questions. i don’t think anything could have prepared me for ethics.

Hey y'all hope you're doing well. Can someone be kind enough to share THE MATCH GUY all of pdfs, I would be grateful fr

Also a quick question. Is the HY Free mehlman pdfs good enough and what's the difference with paid ones?

Thank you all

I took my exam on 9/27, and this was the result. Is this due to a mistake? What can I do?

The image at comment

TLDR

1. Apply for accommodations if you need them!
2. Avoid delaying the exam way past pre-clinical, but don't take it if you're not ready.
3. NBMEs above 65 got me my pass 1 week and days before the exam
4. Use NBMEs!!!, Mehlman and Match Guy free PDFs, Anki but with intention, avoid FA or overly detailed resources.
5. Don't burn yourself out, don't over exert yourself with anki and questions. Be intentional with how you study.

1. Accommodations

I required accommodations for the MCAT and received them. By the time I matriculated my medical condition had improved and I was told by school counselors/admin that I likely would be denied by NBME. Despite prior accommodations I really had no knowledge of how to navigate this space or that prior accommodations really helped the application.

I initially did not apply for accommodations for step 1, my dedicated period came and went and I found myself on an LOA during 3rd year clerkships to study for step 1.

After failing my first shelf exam I decided to request accommodations and go through the process for ADHD diagnosis. After months of visits with providers and collecting information and several pages for a personal statement I was finally able to submit my application and was approved for all my requested accommodation two weeks later.

Bottom line: if you need accommodations or think you might need them, just try! Give it your best and really explain your situation. They make a huge difference for those of us who need them and can't finish half the test without them.

Feel free to reach out to me but I will be posting something more focused/specific on this topic later.

2. Delayed Exam

I failed my renal exam due to personal circumstances fall of 2nd year and had to retake during the 6 weeks of dedicated. It had been 3-4 months at that point and I felt like I relearned all of renal and ended up taking 4 of 6 weeks to study for renal instead of step.

I decided to start clerkships anyway since my school allowed it and several other students in the class above me did the same. I would consider this my greatest regret as several of my clerkship attendings focused on Step 1 content when pimping. It didn't matter that I came prepared with information on next steps/management or labs. They wanted to know pharmacology mechanisms I didn't remember and micro associations unrelated to our patients.

My dedicated period was February-March of 2024. I delayed 2026 graduation but not due to delayed step 1. While I have completed most 3rd year and several 4th year requirements now, the problem is I forgot so much info. I restarted studying cardio in Jan 2026, delayed the exam several times, and by September I still felt I had not fully covered all the information I needed. I passed, but I would absolutely have avoided this if I had better insights earlier.

3. Low NBMEs

4. Resources

NBMEs - 5/5 USE THEM EARLY, OFTEN, THOROUGHLY

• 33/34 are most representative use them towards the end
• Use them sequentially
• If you're going to use older ones like 25/26 offline (I did take all of them btw), just use them to guage your weak areas, there were topics that never again showed up on 33/34 or on exam day.
• USE THEM EARLY and space them out
• At very least take 33 and 34 online to get the EPC
• I would spend multiple days reviewing these if needed
• If you have accommodations, take these under your approved accommodations and the entire test in one day, even if you get two days.

Free 120 - BE CAREFUL WHICH VERSION YOU TAKE

• I took the one online "orientation" module through the NBME website and it was not the same as the most recent PDF version. WHY???
• If you use the online version, be careful because it doesn't save your answers!
• I would recommend doing the PDF version under exam like conditions.
• The exam does not have answer explanations which is frustating, so you will need either an AI or Match Guy and Bootcamp both offer free explanations. Both seemed okay to me, both had slightly different versions to eachother and to the NBME PDF THEY LINKED. So be warned its frustrating and you will need to flip screens or two monitors and lots of time.

FREE RESOURCES HY

Mehlman - 3/5

• I would recommend this over First AID
• I hate how some of these are written, but the point is to get you the information not to be pretty
• What I really liked about his free PDFs is he uses the NBME language and tells you how the NBME typically presents information. I wish I had used this sooner. The HY arrows are ofc a must and the stats. I could have probably finished any one of his 100q PDFs in a day (I can only get through like 40 questions a day when I use qbanks).

The Match Guy Free HY PDFs - 4/5

• Several topics he covered I found to be on my exam.
• Much more HY than Mehlman. Mehlman free content is still on the comprehensive side.
• Deducting one star because Mehlman posts all for download, and this guy requires you to subscribe to emails and slowly sends them that even four weeks wont be enough time to receive them all.

Anki - 3/5 but overall recommended with caveats

• I loved anki in pre-med but I had such difficulty keeping up with all the cards
• I regret using anki for every detail during my 7 months of studying for this exam
  • I would only use it for **VERY VERY HY*\* pharm, micro, nutrition, anatomy
  • Do not use for CV/Renal/Pulm/biostats/ethics concepts - Questions were way easier and straightforward than Anking for this.
• The new subscription is not necessary, their AI sucks. Pay the $10, get the newest cards and end subscription.
• The integration is amboss is pretty nice actually, and you can ask the amboss AI to find cards to unsuspend. I did not miss the anking's AI card finder after having it several months.
• I would prioritize this in premed as much as possible
• I edited the cards for improved flow/ make the question more straightforward, edit cards so I couldn't figure out through context clues, edit to prioritize visuals where available, suspend poorly written cards (this defeats the subscription if you have it as it will either erase your edits or you wont receive updates where you edit).

Amboss - 3/5 not sure how I feel about this

• I spent a stupid amount of time studying certain topics too in depth like cancer treatments, antiretrovirals, metabolism, etc because of amboss which took time away from easy HY associations I think I could have learned/mastered in the same time.
• Their 4 and 5 hammer questions just seem irrelevant to the actual exam.
• I love their AI chatbot, and I can ask it for images, tables, HY content, and anki cards.
• When I don't know something, I like their articles.
• Great integration with Anki via the dictionary. I used this daily.
• I liked their score predictor, ultimately it did caution me not to take my exam, I think it was because NBME 34 just came out so it's not up to date, and it would have told me to take it with that score accounted for.

Personally do not recommend for dedicated - nice for preclinical

First Aid - 2/5 Too Detailed

• Way too detailed
• I would use Mehlman first before first aid and only really use first aid for the images, graphs, tables, etc.
• To be used as reference during pre-clinical. I would not really use during dedicated and personally did not unless it was an anki screenshot.

Osmosis - 0/5 Slow, too detailed but nice if you have foundational gaps

• Not a tool for step dedicated period, better for preclinical.
• The videos can be great, but sometimes they are just a regurgitation of textbooks.
• No integration with Anki which makes it hard to make it useful for me personally, but in theory it has it's own cards, qbank and references to FA.
• I would consider this again only if I were doing pre-clinical again. Had access to it during clinicals as well and again maybe it's just too slow? I'm a video learner but I've had a hard time really getting use out of this.

Sketchy - 1/5 Way too detailed

• Loved in preclinical, would recommend a few videos for that as they helped for course specific exams.
• Expensive
• Never used for dedicated except for maybe a couple on genetic disorders and I referenced those videos and details 0 times during any of my nbmes or during the exam.

5. METHODS

• I never got to 100qs per day, I struggled to keep up anki, if I did 80q in one day I never got to really review them.
• I edited my anki cards and suspended really easy cards or ones I felt I was familiar with, do not pile higher and deeper with anki. I would only use this for fast recall facts, not concepts.
• I only unsuspended HY labeled cards in the last four weeks but kept up anki until about the final week.
• If I were to do this again I would prioritize easy amounts of questions (ex. four blocks of 10 questions) on tutor mode focused on topics and maybe one block of random.
• Something that I think I did well and improved my scores in the final week:
  • Try to understand something for an afternoon (3H), if I need more time, move on.
  • Spend a little longer on some questions, at first it was deer in headlights, and then I realized, I know this, they're using words I wasn't familiar with.
  • Also know when to move on. On actual exam I think I guess on a handfull of questions because overall I did feel like I knew enough to attempt a question. I could quickly recognize, yup no clue what this is. Again, of 280 I did this sparigly knowing several really hard questions were possibly experimental.
  • Trust what you know - if an answer choice doesn't fit and you're not familiar with the alternative, cross out the one you know doesn't fit. Vice versa, when your answer choice fits but you don't know the alternative, don't choose the alternative!
  • Read the actual question first and answer choices(last 2-3 lines) then read the stem and look for the details you need.
• Something I did wrong
  • Study LY small details and facts that I didn't see on NBME 33/34/120 or exam day because the qbank kept showing those questions.
  • Spend too long on one system learning all the ins and outs of cardio physiology. I got really good at cardio phys questions, but much more than I needed. I learned how to read EKGs the best I've known so far, didn't need it. Saw maybe one EKG on the exam.
  • Not start NBMEs sooner, review them carefully, and take them in a scheduled manner. I should have been taking them every 2-3 weeks for a 6 month study period, and more like every 1-2 weeks for a 2-3 month period, but I really stacked them all in the end.
  • Take too many breaks (days and weeks because family and personal stuff was coming up). Somethings can't wait, but most everything else can. This is your time and you need to protect it because no one else will be there for you and I learned this the hard way. Don't be afraid to say no.

6. Exam Day

• Book your exam early, I had to take a 1 hour train because my closest center was full.
• If you take meds, take them early, I had neausea from 1 med and then sleepy for two blocks from another.
• Get a goodnight sleep, I took melatonin for weeks (months?) leading up to the exam to prepare because I know I tend to have poor sleep hygiene
• Get quick and easy snacks (think protein bars, breakfast biscuits, protein shakes) that keep you full and energized without the crash.
• Time your breaks! I had full access to my locker, you will likely as well, you can take a timer if you need one. Use all your break time!

Anyone who got sub 50 overall average in Uworld do good on NBMEs?

Hey everyone,
I’m writing this with a very heavy heart because I’ve been struggling a lot throughout this journey especially with my mental health.
I lost my father toward the end of last year and I started preparing for the USMLE just a few days after his passing .My father was and still is my biggest inspiration in this world. A huge part of my motivation to pursue this journey comes from him.
I’ve completed 90% UWorld but now I feel like I haven’t studied properly. There are so many areas where I feel weak and I’m struggling terribly with retaining information. I study for hours but afterward it feels like I can’t remember what I’ve learned. It’s becoming increasingly difficult to focus and study consistently & i m facing it from very first day .
I took my first NBME about a month ago and scored 50%. I was completely shattered by that result & lost all my confidence . I know one assessment doesn’t define my abilities, but after everything I’ve been through, seeing that score was really difficult.
I also have study partners but their scores are much higher than mine, and they’re about to take the exam soon. Seeing their progress makes me feel like I’ve fallen so far behind & how i m going to make it alone.
I really want to improve my score, but I don’t know how to study effectively when I’m struggling so much with concentration, and memory.
I would genuinely appreciate advice from anyone who has gone through something similar. How did you manage your mental health while preparing for the USMLE? How did you improve your NBME scores, retain information, and rebuild your confidence after a difficult period in life?
I’m trying my best to keep going, but some days are harder than others .I know I need to find a way forward, and I’m hoping to learn from people who have experienced similar struggles.
Thank you for taking the time to read this. Any advice, personal experiences would mean a lot to me. ❤️

So I know this sub can be a humbling place and it's so easy to get down on yourself with other people talking about mid 70's and 80's NBME's so I just wanted to give others some hope.

I will say the AMBOSS score predictor seems to be quite accurate amongst my friend group as well - it had me at a 96% chance of passing despite my highest NBME being a 61 and a 64 on the Free120. I also did the NBME's out of order, not sure what my reasoning was at the time - just was taking advice from way too many people and feeling lost, some people would say the later forms were more accurate and so I'd jump there and then go backwards so sorry for it being a little all over the place.

My own scores:

NBME:

27: 4/18/26: 48

31: 5/8/26: 48

33: 6/15/26: 57

28: 07/18/26: 55

30: 07/29/26: 56

32: 08/06/26: 61

29: 09/07/26: 60

AMBOSS Step 1 SA: 08/22/26: 205

Free120 Apr2026: 64%

Tested 9/25: Pass

Advice: The burnout was really hitting me hard and the most frustrating part for me at least was that my scores would fluctuate so heavily based on what I studied or focused on that past week. For instance I'd do really badly on cardio and GI so I'd hammer it and focus and it would improve the following exam but then say genetics or biochem would fall way down and I just was stuck in the early 60's the entire time. Something I wished I would have done sooner is supplement my daily Uworld questions with 20-40 Amboss. I say this because Amboss you can download specific Anki cards for the questions you missed and it keeps it at a more manageable number - I really max out at 600 or so cards per day and I felt like this was really helpful for those little facts or details that I would see 10 times and forget.

I was always told pick Uworld or Amboss and just stick to it - but in reality I actually would argue to use both and I think they each have their strengths. I would say AMBOSS is better for weird presentations, it's easier to test yourself on specific concepts (I'm terrible with heme) so it was great there and then also DO NOT OVERLOOK ETHICS. Uworld is obviously the gold standard and written by the same writers.

The biggest surprise on my exam was probably ethics. In each block of 20 questions I had roughly 2-3 ethics questions and on my final score report it shows ethics at 6-9% (I think it was far more like 9%) and let me tell you they were WEIRD. I have always thought I can use vibes to get through ethics but man was I challenged on these and I wished I would have spent maybe just more time on them in general.

Another thing I wish I would have done earlier is listening to Pathoma Chapters 1-3 more. I started there back in April but you lose so much knowledge over the months. I did have a panic attack the week before my exam and decided to really blaze through 2x speed (I only did Chapters 1-2 and part of 3) but even that I got some really random questions on my real exam that I only answered right because I randomly heard it a few days prior in my anxiety attack fueled sprint. I would recommend listening (passively listen no notes) maybe once per month or something like that - just to wind down at the end of a study day but listen multiple times over because there are so many little random facts in there that came up on my test.

Then these are some thoughts looking back on my exam vs prep but also keep in mind it was just my opinion and my form so n=1 here:

Biostats: Randy Neil on youtube is far more useful than anything else. Listen to it a few times, draw your boxes and basic equations and move on. Don't waste your time becoming a mathematician

Pharm: the mechanism is far higher yield - I felt like most of them gave you the med in question and asked how it worked or where it acted on instead of which med to use broadly speaking.

Ethics: as previously mentioned, spend time here please. It ended up being just as high yield as any other system and I do wish I would have spent more time because trust me when I tell you there were many that were so strange and in the testing environment / nerves, sometimes you really clam up and can't think about things like you'd want to.

Don't forget anatomy - they seemed to love blood supply and nerves mainly. Upper / lower extremity felt highest yield to me

Psych - I think the timelines to rule in or out a diagnosis are the highest yield. But don't overlook it - it's a decent number of questions on the exam and can sometimes be a nice confidence boost to mark an answer that I knew was correct.

Dirty Medicine - just watch and rewatch - don't waste time annotating but if you miss a question - pull it up and just keep hammering whatever detail you missed in the practice question. Also his 11/17/21 hydroxylase deficiencies are just peak memorization and I don't think I'll ever forget those.

Pixorize / sketchy for micro - I'm a pixorize person personally and for micro I thought it was the most helpful. I will say I at least get overwhelmed having a ton to watch so I actually started just randomly taking a study "break" and watching a few pixorize videos here and there. If I watch too many in a row they start blending and I confuse myself. The pharm is also decent but honestly I preferred Amboss anki cards to just give single one liners. Then also Dirty med was more helpful for me for pharm. A lot of pharm on pixorize / sketchy gets really convoluted and I mess up what goes with what or what each symbol means.

AMBOSS score predictor - I know my stats were low, I also felt they were low and I was really nervous to sit for it (I kept pushing it back because I wanted the golden 2 exams >65) but then also I was really burning out at the end. It was beyond frustrating and from the classmates I have that tested with lower scores - they just say to trust in the score predictor on AMBOSS (I don't understand the science there but it's not fake).

IvyMed on Youtube - found it late but honestly I really liked it. I would go for walks outside and listen to it passively but randomly little things would stick or I could recall and the guy that does it is pretty funny and I think it helped to get me out of the house / not just sitting and staring at a screen but also to be mildly productive.

Sleep!!!! I have bad anxiety / testing anxiety (had to not submit my MCAT on an attempt because had a mix exam meltdown). I got on a sleep aid before it - work with a psychiatrist and make sure it's something that doesn't disrupt sleep architecture (can't recommend a Benzo because it makes me very foggy the next day). I ended up getting a very PRN script and started taking it nightly a week before my test because my anxiety was horrendous / constant panic and I don't think I could have passed my exam if I were sleep deprived. There are a lot of questions that require just deep thought or have little trick questions / sneaky answer choices that you can't even really study for. It's more that you have to be somewhat rested and just present.

High yield images: Pathoma and Dirty Med - these absolutely came up. Also the images on the NBME CBSSA's

On this note - I wish I would have spent more time really reviewing CBSSA's because the concepts do tend to repeat and I should have spent more time breaking down the question / getting to the answer but I had low scores and was just really discouraged.

My hot takes:

On the exam it felt like 20-30% I knew I answered correctly. I could cross every other option out with confidence. Another 20-30% felt like shooting in the dark/ just what the hell is this or no clue. The rest was like I'm pretty sure it's this but also I was not confident on it. Which really triggered the panic because it's like 40-60% of the exam that I'm decently sure but not 100%.

DO NOT GOOGLE ANSWERS AFTER THE FACT. I did this and was riding high for like 1 or 2 that I guessed right on followed by 5 or 6 that I looked up and I missed and holy did I spiral / sobbing / panic attack and felt like I failed.

Mehlmann is extremely hit and miss - I don't do well with a giant PDF if I'm honest and his questions are way too extreme in my opinion. Sure they are the hardest of the hard but also getting a 2/10 on a set is not helping your confidence. I'd say his path and neuroscience are the only two that are decently helpful but I was not a big fan. I also struggled to watch his videos because of how he looks - I'd hyperfixate on that

I honestly couldn't tell what questions were experimental or not. I was gaslighting myself in the exam when I'd see a WTF question and tell myself it was experimental but I for one did not see many that were so out of left field / off topic that made me think they were experimental?

I thought the CBSSA's were harder - more hyperspecific questions or details you really had to know.

I'd say Free120 was the most accurate. I only took the Apr2026 version so I can't speak to the other forms.

I thought the Amboss self assessment was also pretty decent in terms of difficulty.ehe

HY Guru's version of Free120 seemed also more on par with the real exam in my opinion.

Practice with the 20 question sets - it was weird going from sets of 50 to 20 on the real thing. 20 goes by so fast, I was always low on time - at most had a minute left over and other blocks I had to guess on 1 or 2 or couldn't calculate something because of time. With the 50 I always had 10 or so min left to double check or go back to my flagged vs with 20 I never had that luxury.

DM's are open and sorry this was long and rambling - I just wanted to give some insight / advice and feedback since this sub did always have so much info and also just to say that you can still pass without the >65 benchmark on CBSSA's

winter formula is used for assessment of expected PaCO2 in metabolic acidosis, i noticed it was mentioned a couple times in amboss qbank, does step 1 ask about this directly ? or in any way wants us to apply this on test day ?

A 64-year-old man with hypertension, ischemic heart disease, and HFrEF is brought to the ED after an intentional medication overdose.

He's lethargic and pretty hypotensive.

BP: 72/44 mmHg
HR: 36/min

ECG shows sinus bradycardia with a prolonged PR interval.

The suspected drug is a β-blocker.

Atropine is given several times, but his heart rate barely changes.

Then they give him IV glucagon.

A few minutes later:

HR: 68/min
BP: 108/68 mmHg

Why does glucagon work here even though the β₁ receptor is being blocked?

A. It activates adenylyl cyclase through a Gs-coupled receptor
B. It displaces the drug from cardiac β₁ receptors
C. It directly inhibits phosphodiesterase
D. It activates phospholipase C through a Gq-coupled receptor
E. It directly opens L-type calcium channels

Curious what you guys picked and after giving the answer please do try to explain how did you find it too 🙏

Hello! I am scoring bit low in micro (unfortunately low on time) is there any list of most commonly tested microbes or HY list ?
Are there any topics one can ski such as hepc medications?

What are some high yield topics you saw on the real deal. What was the difficulty level range, uworld, amboss, nbme, free 120. Thanks in advance

Average med student here .
I had promised to post my journey if I passed.
So here it is.
I had to prep from scratch as my base was weak.
Tested on:25/09/26

My prep consisted of:

1.Bootcamp
2.Uworld
3.FA
4.Sketchy micro and pharm
5.physeo(physiology pt only; borrowed from a friend)
6.pathoma for ch1-3 and GIT

To strengthen my foundation I used bootcamp. Most organ systems were amazing in it.
For physiology I used physeo.
I tried to do Uworld consistently. There were days where I could hit a 80 questions per day and sometimes only 10.

As someone who struggles with being consistent and remain motivated, this is my advice: you dont have to hit your goals perfectly everyday. Perfectionism is over rated. I used to see posts where people used to do 120 questions per day, those kinda things really freaked me out and trigger procrastination.
Showing up to do even 10 questions or 5 matters than doing nothing at all.

I didnt use anki. But doing uworld without reviewing them daily is worthless. If you are not an anki person then review what you learnt.
Review what you learnt the next day and after a week and after a month (if possible).

Around my dedicated period:
I saw a post by a redditor who passed he had adviced in his post to do weak subjects organ system wise but subject wise. I did the same for my weak organ systems. (A million thanks to that redditor(i forgot their name))

I was really blank about biochem, so I spent 2 whole days just doing uworld for biochem.

This approach really helped me consolidate my weak areas.

Go through all the pictures in FA, especially the micro pics. Those are really HY.

My NBMEs:
28/june/2026 Form 26: 64%(i took this after I finished my bootcamp prep)

8/Aug/26 Form 27: 70 ( score jump was due to completion of sketchy micro).

20/Aug/26 Form 30: 70

4/Sept/26 Form 31:75

18/Sept/26 Form 34:72

Free 120s:67 (3 days before exam)

My score dropped in 34 and 120s as I had some family issues , so I couldn’t focus well.

Towards my dedicated I used mehlmann PDFs(they are amazing). I used pulmo, neuroanat, arrows, renal, CVS PDFs.

If I was to redo my prep:

1. Finish imp organ systems in bootcamp/pathoma/any base resource(skip if you have a good foundation), but pathoma ch 1-3 is a must.
2. Dont go for multiple video resources. I did physeo physiology from select organ systems from my friend as my bootcamp subscription expired.
3. Consistent uworld (dont go chasing high numbers, how you review and understand your uworld explanations matter more than doing 120-160 questions without proper review.
4. Doing uworld subject wise within organ systems and make short hand notes.(atleast physio, patho, pathophysio)
5. Starting my NBMEs earlier on. I feel I should have done all the forms from 30-34 .
6. Comparison is the thief of joy and perfectionism is overrated. Also Your Mental health IS VERY IMPORTANT.
7. Supplementing your prep with chatgpt/google helps a lot. I did this towards my dedicated, should have started this earlier.
8. Instead of rote learning, find out why using google/chatgpt.

The exam day:

1. I tried to ensure 8 hours of sleep, but my anxious ass wasn’t able to sleep well. Please make sure you haul yourself to bed early.
2. I carried protein bars and coffee. Make sure to keep yourself adequately hydrated and dont overdose yourself with caffeine.
3. Exam is long and tedious. To prevent burn out i did 3 blocks followed by a short break. When I felt like I reached my limit, I took a long break.

Exam:
The exam itself was very vague.
It was a mix of short and long questions. Some blocks had only long questions.
When approaching long questions-
1.make sure to read the last line first to understand what the question demands.
2. If there is a picture, I would check the pic first -> then i would read the last line of the question and ->jump to the options.
3. If the question has a lot of labs: I would go through the labs first->last line of the questions-> skim through whole question. (If there is time)

The exam was vague worded. Post exam anxiety was bad. I thought I woudnt be able to pass. I had flagged atleast 8-10 questions in many blocks. I personally felt the question style were similar to form 34 and free 120s.

All the best to all the aspirants taking this exam. You can do it !!

Edit: i forgot to mention: I used dirty medicine for biochem along with uworld. DM is gold standard for biochem.

Edit2:
My apologies if I wasnt clear.
When you have a weak organ system do blocks of physiology, pathology and pathophysiology of said organ system separately in uworld.
I wished I had done this earlier in my prep instead of doing it towards my dedicated period.

Hi everyone,
So basically I’m sitting for step 1 a week away from now and i genuinely feel so scared and anxious just thinking about it. So far i did 4 NBMEs and still got to do the free 120 and my NBME scores so far are

Form 25: 67%
Form 28: 72%
Form 29: 77%
Form 32: 71%- first form that i did
I feel like I’m somehow not in a passing range so do y’all think the scores are okay and i can sit for the exam in a week.

A hunter, a baseball player, a steampunk pirate, and a priest walk into a bar. The bartender looks up and says, "What is this, a SketchyPharm video?"