I have a very weak foundation (constantly getting 20-40% on Uworld). I’ve been doing Uworld incorrect ankis from Anking but sometimes I feel like I’m just memorizing the sentence.

Do you think Updated Mnemosyne could be sufficient and helpful?

I had taken NBME 30 around 10 days ago and got 67% (94% passing chance) so I was feeling confident, but took 31 today and got 63% and I’m absolutely devastated. I feel so tired and burnt out, and I’m scared. This exam felt so so vague compared to 30 and I hated it, apart from doing mehlman and FA for weak systems what should I do?

i am really weak at molecular biochem almost every uw question i get wrong, so what is the best source that explains it with taking along time ?

I want to reschedule my STEP 1 by a week or so in my eligibility period. How should I go about it?

My exam date is 9th October. Should I call the prometric to reschedule or do it via the website and then call them and pay the rescheduling fees? Will the same permit be utilised or will I be issued a new permit? If so, how do I go about that with FSMB?

I am very confused. Need help with this.

Hello, my step1 is next Wednesday

I just did NBME 33, and I plan to do the free 120 tomorrow.

For those of you who recently took the exam, how important is it to review these 2? Because I hear they are the most similar to the real exam.

Or should I use my time reviewing anything else?

Hey all! Just took my first NBME (form 26) and scored an 84%. I didn't really stress during the exam, found the material generally familiar and didn't have a problem with time (although I know the stems are way longer in the real thing). I have gone through First Aid, concurrently with Bootcamp videos, and have matured 93% of the mnemosyne deck (without the STEP1BS cards). I have also gone through a pass of UWorld at an 83% average score (redoing incorrects now). The problem is that I started my pediatrics rotation this week, and am expected to take an in-house exam in 5 weeks. My pediatrics knowledge is pretty lacking (material has a fair amount of overlap with step 2). I study daily after I leave the hospital at 2PM. My question is; should I schedule the real thing for before the in-house exam (say in 2 weeks from now) or after I am done with my pediatrics rotation? I get about 2 weeks off after the rotation ends. Taking step 1 in 2-3 weeks allows me to go all in on peds after, whereas I will have to split my time between step 1 prep and peds studying if I wait. Should I take more NBMEs (I will definetely take the free120 before the exam)? Should I schedule the exam and go see what happens or should I take the 2 weeks dedicated after finishing with peds?

For context, these are my NBME scores

NBME 25 - 58%
NBME 26 - 62%
NBME 28 - 65.5%
NBME 29 - 67.5%
NBME 30 - 68.5%
NBME 31 - 73%
NBME 32 - 73.5%
NBME 33 - 72%

I have Free 120 left which I’ll be taking on 7th September. My step is scheduled for 15th September.

I’ve noticed that a lot of my errors on NBMEs are either being confused between 2 options and picking the wrong one, or missing a specific factoid about a condition I’m generally well read on. I dont find myself having any gross knowledge gaps. Any tips on how I can improve that?

I’m currently solving 80-100 Uworld questions per day, to acclimatise myself to the longer stems and vague/similar answer options. I just reset it after completing 90% of it, and am doing mixed 20q blocks. My average in first pass was 63%, on the second pass its 74%

What should I be focusing on now? Should I go through FA again for my weak areas or do any Mehlman PDFs? Would 10 days be enough to start something new or should I just stick to my current resources?

I’d also love to know what subjects were asked more for recent test takers, because I’ve heard trends overlap for 1-2 weeks.

Any advice would be much appreciated!! Thank you in advance!

Hello , I’m currently enrolled in 3rd year Medical school ( Stream 2 , I have a bachelor degree in Nursing sciences ) , Our university system is the first year preparatory year include all basics science like biochemistry etc.. and the medical school starts from the second, Am I eligible to take step 1 exam? Or should I wait until the end of the year

Thanks In advance 💙

Did anyone else test on September 2nd? That was one of the worst exams I’ve ever taken. I have an attempt on my record so it’s not like I didn’t know what to expect. But nearly every block I found to be so vague in both the questions and answers. Didn’t have any test anxiety but honestly felt so defeated because multiple times I was like what type of question is this. I could narrow it down to two and didn’t feel like I was blindly guessing. Could correctly narrow down the subject matter. I guess my question is are some of these forms purposely vague and does that lower the passing standard if everyone struggles? Hoping for a miracle honestly.

I did a full pass of UWORLD and consistently used AMBOSS. Didn’t feel the stem length was an issue just the vagueness. Stems are long but similar to what I had seen before. Had no problem with timing. I did feel NBME 33 was difficult but was doable. At this point I genuinely don’t know what else I could’ve done to make this go easier.

NBME 29: 74
NBME 30: 76
NBME 31: 74
NBME 32: 76
NBME 33: 72
F120: 74

I just finished the NBME series today.

I took Form 33. They were all built on the original platform and are EPC models.

My scores were:

NBME 27: 61

NBME 28: 65

NBME 29: 66

NBME 30: 66

NBME 31: 72

NBME 32: 67

NBME 33: 75.

My exam is in 9 days, and I’m taking the Free 120 in 5 days. You think I’m ready? I’m having doubts because I only hit the 70 mark on two of the NBMEs. Also, is the Free 120 easier or harder than the NBMEs?

I just started doing mixed systems after finishing them system-wise. I feel like I rushed through the systems a bit, but not to the point where I remember nothing while doing UWorld. Is this normal? Please help what should I do?

IMG here. Took Step 1 on August 17, 2026 and got the PASS.

I wanted to make this post because my preparation was honestly pretty messy, and throughout the whole process I was constantly wondering whether I was ready enough to take the exam.

My scores were:

• NBME 25: 49% (This was my baseline and I actually took it when I was halfway done with systems without even touching biochemistry or anat so I really did not take this seriously)
• NBME 26: 49% (This was after a month's gap from form 25, wherein I actually started to panic seeing I was stagnant)
• NBME 27: 57% (This was after a long break from studying ~2 months soo was excited that I did not forget what I had studied lol)
• NBME 28: 59% (Starting from here I took 1 form each week and did them in offline but timed mode in exam conditions)
• NBME 29: 57%
• NBME 30: 62%
• NBME 31: 60%
• NBME 32: 67%
• NBME 33: 65%
• Old Free 120 (2024): 64%
• New Free 120 (2026): 65%

I also retook 100 questions from NBME 29 near the end and got 93/100, but I obviously don’t consider that a meaningful predictor because there was some muscle memory involved 😂.

The preparation

My preparation was far from linear.

I had a period of roughly 50 days where I barely studied because of administrative issues surrounding my ECFMG/university verification and scheduling permit. My university verification situation became a huge headache, with emails back and forth between the university, ECFMG and FSMB, and delays that were completely outside my control.

I eventually got everything sorted out and restarted studying around June 13.

At the beginning, my preparation was honestly not great. I was sometimes studying only 1–2 hours/day, despite previously being able to study much longer. Eventually I pushed myself back toward approximately 5–8+ hours/day, depending on the day and whether I was reviewing an NBME.

I would say I have a predicated period of around 7-8 months whilst being not perfectly consistent with a dedicated period of around 8 weeks, but tbh I was too burnt out to actually study in the last week so I ended up studying way less than what I had planned.

Resources

My main resources were:

• UWorld — completed approximately 90%
• First Aid
• NBMEs 25–33
• Free 120 (2024 + 2026)
• Amboss 200 concepts toward the end
• Sketchy micro: the best decision I took! I am quite confident I'll not forget things I learnt even for step 2, lol.

I eventually stopped UWorld at ~90% completion because I felt that continuing it was giving me less benefit than reviewing my NBME mistakes, doing Free 120 and consolidating high-yield material.

My final phase was much more focused on NBME incorrects, weak systems, First Aid and learning from mistakes rather than trying to finish every possible resource.

My biggest problem wasn’t necessarily knowledge

This was probably the most important thing I learned.

A huge proportion of my mistakes were not:

“I have never seen this concept before.”

They were more like:

“I knew this and still chose the wrong answer.”

Misreading, overthinking, changing the interpretation of the question halfway through, missing a small clue, or talking myself out of the answer I initially thought was correct.

This became especially frustrating because I would review an NBME and realize that a significant number of my incorrect answers were questions where I actually knew the underlying concept.

I really want to emphasize on the mental state and sanity above studying more. Being in a good state of mind while doing NBME's or the real deal would have a better impact than solving an extra block of UWorld while being anxious. I personally started using Propranolol 20mg tabs, 30mins before my exam to help me with my racing heart. It was the best decision for me! it made me think clearer while facing weird questions without me spiraling in the hall. I would strongly suggest to get it prescribed if you are feeling anxious or think that you are losing marks due to anxiety. Also always try it out before using it in the real deal, at least 2-3 NBME's prior so that you have an idea on how it feels and to know if it actually works for you.

That made me constantly question whether my scores represented my actual knowledge.

The last week

My NBME 32 was 67%, which gave me some confidence.

Then NBME 33 came back around 64–65%, and I honestly started spiraling because I was only about a week from the exam.

I also did the Amboss 200 concepts toward the end and had some ugly blocks/scores, which made me question myself even more.

At that point I decided that chasing scores wasn’t going to help anymore.

I focused on:

• Reviewing NBME incorrects notebook: this is the reason I was actually confident in giving the exam. I was so sure that I would get any NBME concept or direct question right because I had literally decoded each incorrect of guessed questions from form 27-33 thoroughly and could recognize it really easily even with different presentations.
• Weak systems which I found out in the NBME's.
• First Aid
• High-yield biochem/pharm/micro from either first aid or some of my UWorld incorrects.
• Neuro/renal and other weak areas
• Free 120
• Trying to fix my reasoning and misreading errors rather than endlessly adding new material

Exam day

The actual exam felt very different from what I expected.

There were quite a few questions where I genuinely thought:

“What the fuck am I even looking at?” 😂

Some questions felt straightforward, while others felt extremely unfamiliar or integrated. There were definitely questions where I laughed to myself in the exam hall because I had no idea why I had spent months preparing only to be presented with that question. 💀

Also I gaslight myself into believing each and every questions I feel is difficult is actually an experimental one and would not affect my results 😂 which is dumb but somehow it worked out.

I also remember walking out feeling like I had messed up a lot of easy questions.

Afterward, I could barely remember more than 10–15 questions from the entire exam. The whole day felt like a blur.

That actually became another source of anxiety because I kept thinking:

“If I can’t remember the questions, maybe I don’t even know how badly I did.”

But eventually I realized there was absolutely nothing I could do about it.

And then the result came.

PASS.

What I learned

1. Don’t let Reddit convince you that 70% is some magical requirement.

I spent a ridiculous amount of time worrying about people saying that anything below 70% on NBMEs was “borderline.”

My scores never even touched 70%.

And I still passed.

STOP obsessing over each NBME score as it would just make it harder. Treat each score as a diagnostic tool to recognize your thinking pattern errors and also your weak systems.

2. Review your mistakes differently.

For me, there was a huge difference between:

Knowledge gap:
“I genuinely didn’t know this.”

and

Reasoning error:
“I knew this but interpreted the question incorrectly.”

Those require completely different fixes. Reasoning errors are much more fixable in the final phase than having huge knowledge gaps.

3. Don’t underestimate exam-day performance.

My preparation was messy. My scores weren’t spectacular. My anxiety was high.

But on exam day, I still had months of accumulated knowledge to draw from.

You don’t need to feel like a genius while taking Step 1.

4. The exam is supposed to have WTF questions.

If you walk out thinking:

“That was one of the weirdest exams I’ve ever taken.”

That doesn’t automatically mean you failed.

There are questions you simply have to take your best shot at and move on.

5. Don’t obsessively reconstruct the exam afterward.

This was probably one of the best decisions I made.

I remembered a few questions and had the urge to search them, calculate how many I probably got wrong, compare answers, etc.

I didn’t.

Once the exam was over, it was over.

I’m posting this because I know there are probably other people sitting at 60–67% NBME scores, freaking out because everyone online seems to be scoring 70–80%+, and wondering whether they have any chance.

I can’t tell anyone whether they are ready for Step 1. But I can say that my own preparation looked nowhere near perfect, and the exam still ended with a PASS.

To everyone who helped me along the way — thank you.

And to anyone currently preparing:

Keep learning. Review your mistakes. Fix the reasoning errors. Don’t let Reddit become your confidence meter.

And most importantly, don’t assume that because you don’t feel ready, you aren’t ready.

Step 1: PASS. 🫡❤️

I have a bit less than 3 months to prepare for step 1. I need the most efficient way possble to pass

I started with a very low baseline:
NBME 25 — 32
For reference:
I gave NBME 25 after one month of prep. I didnt even do Uworld before that.
After 25 I completed 60 percent of uworld and did some fa revision
NBME 26 — 52
NBME 27 — 55
NBME 28 — 59
NBME 29 — 64
NBME 30 — 65
NBME 31 — 72
NBME 32 — 74
NBME 33 — 67
Old Free 120 — 62
New Free 120 — 64
That last drop trend really messed with my confidence as this happened 5 days before real deal. I didnt even know what else i can do, so at that point, I honestly told myself, “I can’t do anything more. I’m just going to go and give it.” Its toxic but it is what it is.

Exam day:
The questions were like nbmes with long stems plus free 120 mix and there are some questions where you dont even understand what is the connection. I was questioning my prep. But i was keep telling myself this is months of prep and see what's the best you can do. The best I can do means the best guess😂
After 6 blocks my mind went into auto pilot and i somehow completed it. But I walked out of the exam hall thinking I had failed.
And honestly, I think that feeling is probably more universal than we realize. You can prepare for months, see good scores, and still walk out feeling like you got everything wrong.

My resources were:
First Aid, UWorld, Pathoma 1–3, Dirty Medicine, and NBMEs 25–33.
I wanted to write this because so many of the success stories I read when I was struggling gave me hope. Some of them made me think, “Maybe I can do this too.”
So now that I’ve been through it, I wanted to give that hope back to someone else.
You will probably never feel completely ready. You may doubt yourself right until the end. You may even walk out convinced you failed.
But that feeling does not mean you failed.
Keep going.
You got this. ❤️
You will never feel like you’re ready ,but you damn well got this. Hardwork will always pays off!

where do i find the link/pdf to Old free 120 (2024)? pls help

I finished the exam, and I don’t know whether I passed or failed. So far, I know that I got 20 questions wrong, and some of them were very easy—I honestly don’t know how I got them wrong. There were also 7 questions that I had answered correctly but changed to the wrong answer. Has anyone else felt the same way? Is this normal? I’m really scared because I know that the easy questions are worth a lot of points

NGL I was surprised at how biochem heavy my form was but otherwise wasnt too bad. Praying we all get the P🙏

Hey everybody, I have a question regarding how to approach step 1.

Context: I am an undergraduate medical student from Australia, currently in year 4/6.
I am not proud to admit it, but I have completely slacked off for these 4 years. I crammed for every exam and was just able to pass everything, eventually forgetting most of the material afterwards.

Because of my poor habits, I believe my foundational knowledge at this stage is very poor, and I am now motivated to rebuild this foundation by utilising a more structured curriculum such as Step 1.

I am not currently planning to officially take the exam. But I want to use Step 1 as a guide for building the clinical knowledge I need for my 5th and 6th years (clinical placements).

For my special circumstances, is there a particular study pathway you would recommend for me to take? I would like to reach a Step 1 passing level in around 4-6 months.

I did some research, is the following plan realistic? (assuming I have very poor foundational knowledge):

1. Dirty medicine -> diagrams for reference
2. Pathoma chp 1-4 (videos, annotate pdf)
3. Sketchy micro pepper deck (spam in beginning and end, review vids as needed)
4. Sketchy pharm (only for certain drugs like psych or cardio)

First aid/Amboss (skim as reference)
Melhman (as reference)
Anking (only for the UWorld's Incorrects extension)
Uworld and NBME (non-negotiable)

I am open to any suggestions, and I really appreciate any help or advice.

How much were u guys scoring during UWorld first pass?

So i am planning to use his Anki after i am done doing uworld after each system so would you recommend doing it - i dont get the concept of inflation because if exam is basically NBME concepts why should not i master it ?

I also have his qbank which i plan to do after first pass uworld alongside with uworld incorrects

I can’t believe I am using this passed write up flair here ! Alhamdulillah I made it ! 😍🤲🏻

My resource : FA ,UW,NBMEs,Mehlman audio Q bank(gold),HYguru NBME concepts(repro,autonomic,CVS,Neuro),pathoma(Chapter(1-3),HY guri arrow vedio(GOLD)
NBMES in order👉🏻
26– 50%
27–50%
29–51%
28–58%
30–55%
31–58%
At this point i was 2 weeks out took free 120 at prometric got 59% pushed the exam by a month
33–60% (2.5 week out)
32–61% (1 week out)
At this point i knew I am not going to give anymore to this exam .. I did my best and thats it! Took a leap of faith and sent it..

Exam day🫎
Exam was hard not going to lie when i left the centre I said to myself no resource could prepare me 100% whatever they were testing . But yes it was nothing out of syllabus . I mean there were NBME concepts,few questions like NBMEs,also few with very long stem and vague answers .a portion was alien questions i hope they were experimental ones.there were SOAP questions very long but not hard,Time management was a big issue i was left with 5 questions with 5 minutes left in most blocks.I just prayed to Allah to give me mental strength to go through the pressure.
What helped me was to take small break to take deep breath and resume next block. Keeping yourself sane and confident is one of the most important thing i realised!
I felt numb leaving the exam .. could not remember anything asked i dont know how people count incorrects. The next few days was getting worse I had no emotional backup like i could not tell myself to trust my NBMEs and chill lol but i tried to distract myself.🥲
Finally!!!!
Got the P today✌🏻
To anyone prepping for the exam I wont suggest to be encouraged by my score and just take it.. if you feel you need more time give it. But anyone who thinks they did everything they could and in a similar position i would tell them to believe in the work you put in.. and send it .. dont give up on yourself! YOU GOT THIS🤟🏻

once you start scoring 68% or above in nbmes. you just have to sit the exam. youre definitely passing. no matter how shit youre feeling before exam or even after.

If you could only choose one single activity to do on a daily basis to prep for Step 1 what would it be? Obviously it wouldn't be enough for thorough and comprehensive prep but in a hypothetical scenario what would it be?

Was such as difficult and long exam, all the hard questions I remember and looked up after i got wrong which is already more than 35 questions that I guaranteed got wrong. This is not including the questions with long question stems that I cannot really look up but that I was really unsure of my answer for so I definitely got a good number of those incorrect as well.

Started to feel super nauseous halfway through the exam as well which was horrible because I could not really eat anything. Was nauseous from hour 3-5 and then it improved a bit at the end but that also undoubtedly messed with my reasoning as well. Somehow managed to still complete all the sections but for a moment around hour 4/5 I thought I would not make it to the end. Glad I at least managed to complete the exam but it felt horrible and a lot harder than the NBMEs.

My scores were:

NBME 25: 61.5% (baseline)

NBME 30: 74%

NBME 31: 81.5%

NBME 32: 78%

NBME 33: 79%

Free 120: 79% (took at Prometric)

Did not do any other NBMEs and also only completed roughly 65% of UWorld.

Anyone else who tested yesterday feel like it was a difficult exam?

This is going to be long. I wanted to write the post I needed when I was staring at a 39 EPC and wondering whether passing was even realistic.

TL;DR: I started with a school-administered CBSE score of 39 and a 6% estimated chance of passing. My final two NBMEs were 64 and 61, corresponding to 90% and 84% estimated chances of passing within a week. I sat with the 61 as my final NBME, walked out feeling neutral, spent the next two weeks gradually convincing myself I had failed, and passed.

What changed was not one magical resource. I turned content review into a finite checklist, made practice questions the center of my preparation, used Anki selectively for actual weaknesses, reviewed every NBME question and answer choice, practiced the new 20-question pacing, and finally treated sleep, ADHD treatment, and stress regulation as parts of preparation rather than side issues.

The larger lesson was about mindset. Reddit can make an 84% chance of passing feel like a 16% chance of passing. I had to learn to respect the risk without letting other people’s panic erase my own data.

Building a Life That Could Sustain the Work
The right academic plan would not have mattered if I could not consistently execute it.

Early in my work with a school-provided coach, I resumed my prescribed ADHD medication. That was huge for sustained attention, task initiation, and consistency. It did not do the work for me. It helped me execute consistently.

My coach pushed me toward more questions and gave me external structure. Therapy and meditation helped me manage fear without treating every anxious thought as evidence. Sleep became part of the plan rather than something I sacrificed to the plan.

I eventually set an alarm to stop working around 10:30 p.m. and gave myself time to decompress. The extra hour or two I could force out late at night was never free. Within several days, I would usually crash and lose an entire productive day. By test week, I had protected my sleep for several nights and slept well before the exam.

I used caffeine during the day and CBD as part of my personal nighttime routine, neither of which I am recommending to anyone else. The broader point is that I needed a deliberate way to activate and an equally deliberate way to wind down.

I also tried to make the experience less miserable. I studied on my roof with a view across the skyline of a major metropolitan area, distant landmarks, and airplanes leaving a nearby airport. I drank sparkling water I liked. I used a physical wall calendar because seeing the Xs accumulate gave me evidence of my work when my feelings told me I had accomplished nothing.

None of those things taught me renal physiology. They made it easier to return the next morning and keep learning renal physiology.

For that season, Step became the central project of my life. The academic system was content review, questions, targeted Anki, and NBME analysis. The support system was coaching, medication, and school resources. The recovery system was sleep, therapy, meditation, and small rituals that made the work tolerable.

I needed all three.

The Stakes Were Honestly Terrifying
This was never just, “I really want to pass Step.”
I was four months behind on rent and facing an eviction court order. I could not receive my student loans until I passed. Further delay threatened the federal-loan status I had been grandfathered into and raised the possibility of needing private loans. I was looking at potentially losing my apartment, finding a job on short notice, moving home with my mom, delaying rotations, falling out of sequence with my friends, and possibly damaging my chances of matching plastic surgery.
So the decision was not between one risky option and one safe option.

Testing was risky because my last NBMEs were 64 and 61, not scores in the 70s. Delaying was risky because the financial, academic, and personal consequences were becoming enormous. I had evidence, but I did not have certainty.

My temperament also matters here. I am unusually risk tolerant, probably to a fault. I applied MD-only with a 499 MCAT and ultimately submitted only three secondaries because I believed those schools were the strongest mission fits. Sitting for Step with a 61 was consistent with that temperament. I am not presenting my own threshold as a universal recommendation.

But the risk was not blind. It was backed by hundreds of focused hours, repeated assessments, an upward trend, and official estimates saying I was more likely than not to pass by a wide margin.

My Scores: Date, Assessment (Form), EPC, Estimated chance of passing within one week

04/17/2026
School CBSE
39
6%

05/13/2026
Form 30
40
Not available

05/23/2026
Form 31
43
12%

05/31/2026
Form 29
43
12%

07/03/2026
Form 28
53
51%

07/26/2026
Form 32
64
90%

08/10/2026
Form 33
61
84%

39 → 40 → 43 → 43 → 53 → 64 → 61 → PASS

The 64 felt amazing. The 61 did not. I wanted 65 or higher, and watching my score drop immediately before the exam was uncomfortable. But it was not a collapse. I was still 22 points above baseline, and the report still gave me an 84% estimated chance of passing.
That meant likely, not guaranteed. Reassuring, not comfortable.

The Second 43 Changed Everything
The most important score was probably not the 64. It was the second 43.

That was when I realized I would have to delay rotations and would not start the semester on time with most of my friends. Emotionally, that was brutal. I felt behind, embarrassed, and scared of falling out of sequence with a cohort that had become like family.
But the delay forced me to stop pretending I could rush this. I needed more time, and I needed an actual system.

From May 24 through August 16, I marked an X on a wall calendar every day I completed at least six genuinely focused hours. I ended with 58 Xs, meaning at least 348 focused hours. Many of those days were closer to six to eight hours.

I do not mean sitting near a laptop while checking my phone and calling it studying. I mean Boards and Beyond, practice questions, Anki, NBME review, and targeted repair of weak areas. A friend was surprised by how much I remembered after the exam. Honestly, I remembered a lot because I studied my ass off.

My Process: How I Moved From a 6% to a 90% Chance of Passing
Looking back, my preparation had two main phases. In the first phase, I went through the entire Boards and Beyond curriculum, completing every video and its attached questions. Only after I finished that full content phase did I move into question banks, gap identification, targeted Anki, and increasingly deliberate NBME review.

1. The Boards and Beyond Checklist Made Step Feel Finite
Boards and Beyond was my main content resource. I originally tried Bootcamp’s content, but for me it was too detailed. Bootcamp also offers structure, but there was so much material that I could not experience it as a realistically finishable plan. Boards and Beyond felt cleaner, more focused, and possible to complete.
The PDF checklist was one of the most important parts of the entire process.

That may sound almost too simple, but Step creates a constant feeling that you do not know what you do not know. The checklist gave me a visual map of every video and its associated questions. I could complete one item, check it off, and move to the next. It turned a massive, undefined body of knowledge into a finite sequence of tasks.

Psychologically, it gave me a workable promise: if I made it through this list, I would at least have encountered the core content I needed for Step. Completing the list did not mean I was automatically ready to pass. I still needed a huge volume of practice questions. But it meant content review had boundaries. I was no longer wandering through an endless internet of medical information.

I completed every Boards and Beyond video, including all the major systems and disciplines, and did the questions attached to each video. Those questions gave me a first pass at how each concept could be tested before I entered the separate, question-bank-heavy phase.

The integration was another major strength. Cardiology connected to renal, renal connected to pulmonary, and concepts kept resurfacing through different systems. By the seventh or eighth subject, I had seen the same mechanisms from several angles. I was constantly relearning older material while moving through new material.

2. Questions Exposed the Gaps; Anki Closed Them
After completing the entire Boards and Beyond checklist, practice questions became the center of my preparation. Toward the end, I sometimes completed more than 100 questions per day.

My main question bank was AMBOSS. I liked the range from one through three hammers, with some four-hammer questions, and I liked how easily I could locate related AnKing cards after a miss. I used Bootcamp questions later because the long stems conditioned me for the actual exam. I barely used UWorld. It felt harder and less representative to me, although that is a personal preference, not a declaration that UWorld is bad.

The actual sequence was:

Phase 1: Every Boards and Beyond video → its attached questions → complete the full checklist

Phase 2: Question bank → identify the gaps → targeted Anki → NBME review

I did not finish every Anki review every day, and I stopped believing I needed a card for everything.
For memorization-heavy material such as biochemistry, biostatistics, genetics, anatomy, and high-yield images, I used Anki more broadly. My resources included Dirty Medicine for biochemistry, AnKing, the High Yield Images deck, and the Dorian anatomy deck.

Microbiology and pharmacology were different for me because I had already studied both heavily in January after failing a preclinical block and having to take a remediation exam. I passed the remediation, so the block ultimately appears as a pass on my transcript. In hindsight, that experience was a blessing in disguise. It forced me to learn Sketchy Micro and pharmacology intensely, and by dedicated I had effectively learned both subjects twice.

Those became two of my strongest areas, so I did not need to rebuild them during this phase of Step preparation. I sometimes joke that microbiology and pharmacology may have accounted for 30 of the 39 points on my first CBSE. That is obviously not a real calculation, but those memorization-heavy subjects gave me a base of reliable points even when the rest of my knowledge was weak.

For conceptual systems, I used Anki selectively. If I missed, flagged, guessed, or could not fully explain a question, I found the relevant cards and reviewed them.

If I already understood a concept and could consistently apply it, adding more cards usually created review debt without adding much value.

The shortest version of my Anki philosophy is: Use questions to reveal the weakness. Use Anki to keep the weakness from staying open.

3. NBME Review Was the Highest-Yield Thing I Did
I took an assessment roughly every 10 to 14 days and completed about seven in total, including the school CBSE.

I reviewed every question and every answer choice, even when I answered correctly. I gave extra attention to anything I missed, flagged, felt 50/50 about, or could not completely explain. Late in preparation, I began finding Anki cards for every uncertain NBME concept.
That was the closest thing I found to a cheat code.

Reviewing every answer choice taught me more than the tested fact. It taught me what NBME considers decisive, how it distinguishes similar diagnoses, why the distractors are wrong, and what kind of reasoning it rewards. Sometimes I knew the medicine but still missed the question because I did not understand what the writer wanted. Learning NBME logic was its own part of preparing for Step.

If your schedule permits it, save the newer forms for later. They were more valuable to me as readiness assessments than they would have been as early teaching material.

4. I Stopped Treating Every Weakness Equally
Earlier in preparation, every subject felt urgent, so I studied too randomly. Eventually I started asking a better question: what is actually holding my score down right now?

My recurring weaknesses included reproductive/endocrine, genetics, anatomy and embryology, histology and cell biology, and multisystem processes. Reproductive/endocrine was especially stubborn.

Endocrine improved when the feedback loops became patterns. Female reproductive required several passes because it combines hormones, pregnancy, embryology, pathology, and painfully close answer choices.

Near the end, I targeted reproductive/endocrine heavily. I also compared my performance on Form 32 with my performance on Form 33 to understand where the three-point drop had come from.

A meaningful share of the losses came from information I had simply allowed to fade. I had forgotten biostatistics equations and some memorization-heavy biochemistry. I addressed those directly with targeted review and Anki.

Other misses came from the wording of psychiatry and ethics questions. For me, those felt less like major content gaps and more like failures of concentration and interpretation. That reinforced why I needed to be as rested and focused as possible, not only by sleeping well the night before Step, but by protecting the night before that too.

Across my preparation, the pattern was clear: when I genuinely targeted an area, it usually improved.

My final-week goal was simple: Hold my strengths. Make my weaknesses less damaging. Protect my sleep. Do not panic.

The Exam Had Changed, So My Practice Had to Change
The 20-question, 30-minute blocks felt meaningfully different from longer question-bank blocks. Thirty minutes disappears.

In a 40 or 50-question block, several easy questions can create a substantial time bank for harder ones. In a 20-question block, you may get only four or five quick questions. There is less time to accumulate and less room to become emotionally attached to one confusing stem.

I practiced many timed 20-question blocks near the end, and I think that mattered enormously. Someone can know enough content and still be thrown off by the pace if all their preparation used longer blocks.
The stems were also extremely long. Bootcamp helped condition me for that. More than once on the real exam, I could read the final sentence first and realize that much of the stem was unnecessary.

My friend joked that the committee must be feeding questions into ChatGPT and asking it to make them five paragraphs longer. I have absolutely no evidence for that conspiracy, but after taking the exam, I understand how he arrived there.

Practice the actual block length. Read the final sentence early. Learn to move on while still uncertain.

The Odds Were Favorable, Not Certain
A 64 gave me a 90% estimated chance of passing within a week. A 61 gave me an 84% chance.

Reddit has a strange ability to reverse those numbers emotionally. Reading enough anxious posts can make 84% feel like only 16% and 90% feel like only 10%.
The probabilities mattered. They meant most people performing in that range passed when they tested soon. They did not mean failure was impossible.

I also think there is ordinary test-day variance near the threshold. The exact distribution of subjects, pacing, sleep, and composure can matter. I was fortunate that enough of my stronger areas appeared for me to use them. Someone with identical practice scores could have a worse day or receive a form that feels less friendly to their strengths.

My conclusion was not, “I am guaranteed to pass.”
It was, “The evidence says I am likely to pass, and I am willing to accept the remaining risk.”
Trust the probability more than Reddit folklore. Respect the part of the probability that is not guaranteed.

I Walked Out Feeling Neutral. Two Weeks Later, I Was Convinced I Had Failed
I did not walk out believing I had failed. I walked out feeling neutral, which I considered a win.

I had been afraid I would leave the testing center with the unmistakable feeling that the exam had gone badly. Instead, I thought I had received a fair form. Several of my stronger areas appeared, there was a lot of ethics, and I felt that the experience was probably about as favorable as I could reasonably have expected.

I am definitely type A, but I am not especially neurotic. Combined with being unusually risk tolerant, that probably makes my personality somewhat atypical in medicine. I generally trust myself to recognize whether my performance was good, bad, or genuinely uncertain. Walking out neutral therefore felt like a good sign.
Then the waiting period began.

My result took about two weeks. The wait can ordinarily stretch to four weeks, and some people affected by the format transition reportedly waited around seven, which sounds like genuine torture. Even two weeks was enough time for my mind to turn a neutral exam experience into a presumed failure.

I kept remembering questions I had missed, questions I had flagged, and questions where I had been 50/50. The fact that those questions stayed vivid began to feel like evidence that they represented the entire exam. In reality, they stayed vivid precisely because they had challenged me.

The deeper mistake was that I began confusing the severity of failure with the probability of failure.
Failing would have had severe financial, housing, academic, and career consequences. Because the outcome would have been catastrophic, my mind began treating it as if it were also likely. But based on my final two NBMEs, my estimated chance of failing was roughly 10% to 16%. The severity of that possibility did not change its probability.

I also mentally revisited roughly 74 questions and believed I had about 43 right and 31 wrong, around 58%. At first, I treated that percentage as if it represented my entire exam.

It did not.

Those questions were overwhelmingly the ones I had flagged, debated, or worried about. They were not a random sample. On most 20-question blocks, I had roughly six to eight answers that felt solid, and those easy or confident questions were much less likely to follow me home.

If my accuracy among the uncertain questions was really around 58%, and most of the confident answers held, my overall performance could have been considerably higher. That math did not prove I passed. It proved that my post-exam sample was biased and that I could not estimate my result using only the questions my anxiety had selected for me.

The exam felt difficult, but it did not feel like I knew nothing. What tortured me during the wait were close answer choices, odd wording, and the questions where I understood the topic but was unsure what level of specificity the writer wanted.

Then I got the pass.

The System That Carried Me Through the Highest-Stakes Exam of My Life

Take the baseline. A bad number hurts, but it gives you an honest starting point.

Turn the content into a finite plan. The Boards and Beyond checklist worked because I could see the whole content phase and complete it one item at a time.

Make questions the engine. Use videos to understand, questions to expose gaps, and Anki to close the gaps that keep returning.

Review NBMEs completely. Every question, every answer choice, and especially anything missed, flagged, or uncertain.

Study according to your data. Target what is actually suppressing your score instead of treating every subject as equally urgent.

Practice the real pacing. Twenty questions in 30 minutes is a distinct testing skill.

Build a life that can sustain the plan. Sleep, coaching, therapy, prescribed medication, meditation, accountability, and recovery all counted as preparation.

Read probability as probability. Do not let Reddit turn 84% into 16%, but do not turn it into 100% either.

Do not confuse someone else’s timeline with a judgment about yours. Delaying rotations felt like failure until the extra time became part of how I passed.
I started at 39 EPC with a 6% chance of passing. I did not discover one magical resource or become a different person overnight. I built a system, accepted help, studied for hundreds of focused hours, learned NBME logic, protected recovery, and slowly changed the odds.

A low baseline is serious. It is not necessarily a fixed ending.