Sometimes You Might Need to Repeat the Exam Without Failing It—Be Prepared for All Circumstances!

Background:

• Non-US IMG ~ YOG: July 2022. I completed med school within the top 2.5%, which I believe is the initial step in preparation. Shout out to med students: do your best!

• Full-time Job: 45+ hours per week.

• Step 1: PASS (July 2023).

• Total Period of Preparation: ~ 10 months.

• Dedicated Period: 9 weeks + a compulsory extra week “will elaborate on it”

Study Plan and Resources:

🕥 Pre-Dedicated Period: (Active learning and spaced repetition are key)

• I started studying less than a month after completing Step 1, focusing on active learning through question-solving. I used Q-bank explanations as my main review material, avoiding additional resources.

• Creating an adjustable study plan was crucial. I carefully analyzed my schedule, calculating how many free hours I had each day and how long it took to complete an organ system (in days), a block (in hours), and even a single question (in minutes). Life can be unpredictable, so I built in buffer days for potential delays like illness, family commitments, or workload issues and even forgetting studying materials while rushing to work … xD. Initially, it took me about 10 minutes per question to read, answer, and make notes. This meant I could handle about 6 questions per hour, translating to approximately 7 Hrs per block. This helped me estimate the total time needed to finish the Q-bank.

• My approach was to tackle 25–40 questions per day on workdays and 60–80 questions on off days, averaging about one block per day.

• To optimize spaced repetition, I alternated organ-system blocks daily, revisiting each system every 15–20 days. I saved social sciences, biostatistics, and minor systems for later, so I wouldn’t have to repeat them during the dedicated period. This method kept all systems fresh in my mind, a lesson learned from my Step 1 preparation. Back then, I completed one system at a time and had to redo some, leading to unnecessary time loss due to poor planning.

• USMLE Rx: I had a previous subscription for Step 1, which I got cheaply during a sale. I requested to switch it to the Step 2 Qmax, and they agreed. However, after solving 12 blocks, I found the explanations excessive and filled with low-yield information, so I stopped using it.

• UWorld (UW): I purchased a new one-year subscription from a third party to save $100. Unfortunately, after using it for about a month and completing less than 15% of the Q-bank, my account was deactivated for violating the Terms and Conditions, likely due to changes in IP address or email. Despite my efforts to resolve the issue with the UW team, I lost $450. This experience taught me to always go legal and avoid making changes to the account (e-mail, multiple sessions at the same time, ...) if you have financial constraints. I still believe UW is the gold standard for the STEPs, but they should consider offering meaningful discounts or different pricing for low-income countries, as their subscriptions are excessively expensive. This incident halted my studies for 1 month, and I even considered canceling my plans to pursue residency in the US. Eventually, I gathered myself and downloaded an offline UW-2021 version from Telegram groups, which had around 4000 questions (200 fewer than the online UW). It wasn't the best way to study since it was outdated, but I wasn't going to pay another $559 for it.

• Making Notes: I copied and rewrote important information in a Google Doc and sometimes added low-yield, interesting facts. I also took screenshots of high-yield algorithms, tables, or questions I might get wrong if they appeared again. Anki is also a good option for this, but I recommend making your own decks. By understanding what and why the flashcard is there, you achieve better active learning. Using premade decks and skimming over thousands of flashcards is purely passive learning, in my opinion.

⏱️ Dedicated Period: (I combined my annual and unpaid leave to get a total of 9 weeks)

• I was hesitant about redoing UWorld or starting AMBOSS. I preferred tackling new questions and mental challenges over having an inflated high percentage on the second pass of UW since I remembered answers to previously seen questions without really thinking (especially in Psychiatry, Social Sciences, Biostatistics, Dermatology, and all questions with photos or graphs). My negative experience with UWorld’s canceled subscription also influenced this decision.

• I planned my weeks with a mix of resources: 3 days of AMBOSS, 2 days of CMS forms, 1 day for self-assessment, and 1 day for backup and extra resources. I studied 12+ hrs a day.

• AMBOSS (~3,400 questions): I did 120 random-timed questions a day over about 30 days. I reviewed only wrong and flagged questions, skimming quickly over others to ensure I knew the concepts. I ended up finishing AMBOSS with about 83% correct. It’s an excellent complementary and underrated resource, comprehensively covering social sciences, ethics, professionalism, quality, vaccination, screening, risk factors, and H&P style (patient chart) questions—areas frequently tested in the exam. AMBOSS might become the gold standard in a few years, given their affordable prices and frequent offers, unless they raise prices significantly. However, AMBOSS questions can be tricky and might make you paranoid, unlike the generally direct NBME questions, so be cautious.

• CMS Forms: I completed all active forms on the NBME website (a total of 29) using offline PDFs. I timed myself on two different subjects per day (e.g., Psychiatry and Neurology or Obstetrics/Gynecology and Pediatrics), completing them over about 15 days. The questions were definitely easier and shorter than the NBME assessments and the real exam, but their explanations were essential. My scores ranged between 77-97%.

• Complementary Resources:

• DIP: I highly recommend this guy. Regardless of your knowledge base, the must-do episodes include all Biostatistics and Ethics, the November 2020 changes podcasts, and special topics/risk factors (episodes 37, 41, 97, 137, 169, 173, 184, 204, 221, 231, 234, 250, 252, 255, 323, 509). You can supplement with his shelf review series if you feel weak in a specific topic. He shares a spreadsheet with all the episode names and numbers.

• AMBOSS library & Study Plans: Towards the end of my dedicated period, I focused on 200 HY concepts, patient safety and QI, risk factors, ethics, screening, and vaccination plans.

• UpToDate & ChatGPT.

• Boards and Beyond: I only watched some videos on biostatistics and social sciences.

• Reviewing UW Notes: I consistently reviewed my UWorld notes throughout the dedicated period.

• A and B grade recommendations | USPSTF.

• Randy Neil's Biostatistics YouTube Videos

• Kaplan’s 100 Cases of Ethics: This resource is outdated, so I wouldn’t recommend spending time on it.

• Anatomy Shelf Notes: I used these because I felt weak in clinical anatomy and some nerve-locating questions.

Self-Assessments:

• Amboss SA: 247 (77 days out)

• NBME 9: 40 mistakes, 80% (255) (70 days out)

• NBME 10: 32 mistakes, 84% (263) (62 days out)

• USWA-1: 30 mistakes, 81% (260) (55 days out)

• NBME 11: 22 mistakes, 89% (266) (48 days out)

• NBME 12: 31 mistakes, 84.5% (~259) (41 days out)

• USWA-2: 25 mistakes, 84% (265) (34 days out)

• NBME 13: 26 mistakes, 87% (272) (27 days out)

• USWA-3: 41 mistakes, 74% (250) (20 days out) - An outlier, not predictive, recommended for early preparation.

• NBME 14: 25 mistakes, 87.5% (272) (14 days out)

• Free 120-April 2022: 88% (8 days out)

• Online Free 120-July 2023: 88% (7 days out)

• Amboss Predictor: 273 (264-282)

• First Exam: Expunged!!! (July 7th)

• Actual Step Score: 263 (after rescheduling due to a power outage on the initial test date) (July 14th)

Exam Day(s):

1️⃣ First Exam: I traveled to another city and stayed in a hotel near the Prometric center. I was well-rested and ready, arriving early to get acquainted with the environment. The first three blocks of the exam went smoothly, allowing me ample time to review marked questions. However, during the 4th block, a power outage caused by nearby construction halted the exam. The test center had no backup power, and after a two-hour wait, the session was canceled. I waited in darkness for another two hours before being informed that the exam had to be evaluated by NBME before any decision is made.

I submitted a complaint that day, and the next day, NBME informed me they would investigate and involve their “scoring and analysis” specialists to determine if any part of my exam hit the threshold that could be scored or if I would have to retake it. After a prolonged wait of approximately 5 days and several calls and emails, I was told I would need to retake the exam. NBME sent me a new scheduling permit and extended my eligibility period by three months. I decided to take the exam at the earliest opportunity on July 14th. Despite the inconvenience and disruption, I remained hopeful and used the extra time to prepare as best as I could.

2️⃣ Second Exam: I followed my usual routine but found the questions to be longer and more complex, with frequent lengthy H&P-style stems. I struggled to finish each block with time to spare and marked over ten questions per block without the chance to revisit most of them. A few questions (five or fewer) were repeated from the first exam. Overall, the experience was tiring, and I felt my performance was below my usual standard. I emailed NBME after the exam to ask whether I would receive a mixed score from the two sessions or only from the second one, and they responded that the first session was completely expunged. Despite the score drop from what I had predicted, ALHAMDULILLAH I’m satisfied with my final score, which is still above average and meets the cutoff for my desired specialty applications.

✉️ Takeaway: Prepare for unexpected challenges and complications, as they are inevitable in both exams and medical careers. Even on difficult days, give your best effort, as perfection is not always possible

📒 Side Note: I'm interested in DR/IR and would like to be involved with active research projects. If you can help or know someone who can, please reach out to me at v19husam@outlook.com or other social media platforms at the bottom of this page.

Wish you all the best of luck and success! 

Written by: Husam E. Maglad, MD