How I scored 261 – USMLE Step 1 Experience

How I scored 261

USMLE Step 1 Experience

98th Percentile


261! Very happy with my score.

Most important:

  • Find things to make you happy during dedicated. Burnout is real.
  • Towards the end of dedicated, confidence is more important than knowledge. Trust what you know, and for the last week, focus on knowledge consolidation.
  • Use what works for you. Everyone has access to the same resources. Trust in UW, FA, and/or Pathoma. Figure out what helps things stick in your brain and understand them.


  • 75% on CBSSA given by school. I was class average at a top 10 school.
  • 1x Pathoma and 0.5x FA throughout the school year.
  • Made my own Anki cardsthroughout the year. Maximum of 50 new cards per day, on average 30 cards added per day. Tried to keep reviews under 200 per day, and if above that, I would suspend cards. I’m a firm believer that fewer = better for Anki.
  • Did questions from Robbins review, since these questions often showed up on our school exams. Wouldn’t recommend it for Step.
  • Wish I had done USMLERx throughout the year. I’ve noticed that lots of 260+ do more than 1 Qbank, and Rx is probably the best out there other than UW. However, I would highly discourage UW during MS2 because you end up remembering the questions and not the reasoning. I learned little to nothing on my second pass of UW because I just remembered the questions.


  • 3 months of study
  • Used UWorld x1.5, USMLERx x0.5, FA x2, did notuse Pathoma (I had done it during the school year)
  • UWorld 81% first pass, 98%+ second pass
  • USMLERx predicted score 275+
  • NBME 11 (pre-dedicated, 3 months before): 235
  • NBME 12 (2 months before, 0.5x FA, 0.5x UW): 251
  • NBME 13 (1 month before, 1x FA, 1x UW): 258
  • UWSA1 and UWSA2 (~3 weeks before): 265 both
  • NBME 15 (2 weeks before): 275
  • NBME 16 (1 week before): 260 (most predictive)
  • NBME 17 (3 days before): 266
  • Free 150: 92%

Additional Step 1 Notes

  • If you already have a solid grasp of Pathology, skip Pathoma during dedicated. I know this isn’t typical advice. However, I’ve spoken with a few people who have scored in 260 range, and a lot of them only used Pathoma in MS2 and not dedicated. It’s a great resource for building a foundation during preclinical studies, but not necessarily for pushing you into that 260+ range.
  • Avoid using other people’s Anki decks. It will pollute your brain, decontextualizes knowledge, and I don’t think any deck is fully reliable. If you’re going to use Anki, learn to write your own cards. Be sure to understand that Anki is extremely powerful only for memory, but memory does not always provide you context or understanding that are necessary to put knowledge into clinical use and Step 1 concepts..
  • Do NOT treat FA like the bible, or try to memorize FA straight up. I see this recommended all the time and I think that’s a terrible attitude to take. FA is highly abbreviated, has errors, and is missing information in lots of places. It is the single best resource, but the actual test requires abstraction and conceptual understanding that pure memorization is not fully adequate for.
  • If possible, try to understand things mechanistically as much as possible. Before dedicated, I probably spent more time on Uptodate, Wikipedia, and Robbins trying to understand pathophys and clinical context more than I did trying to memorize FA word-for-word. If you’re crunched for time however (e.g. 2 weeks left in your dedicated), just focus on FA.
  • Avoid resource overload. Focus on UW and FA. For everything else, there’s Wikipedia and Uptodate. I don’t think BRS physio, HY neuroanatomy, Firecracker, DIT, or other secondary sources are good uses of time.
  • The test will feel shitty afterwards. That’s normal.
  • I think the optimal amount of time is 6-8wks to study. I plateaued at 8 weeks.
  • I felt that NBME questions were not completely representative. The test had lots of things that I had never seen or thought about before and I walked out of the test thinking I had done a lot worse than I did. However, the score prediction from my last NBMEs were indeed predictive. In other words, the NBMEs predict but do not perfectly emulate the actual test

Preparation Time

  • 3 months of dedicated study

Books Used

  • First Aid for the USMLE Step 1
  • Pathoma

Question Banks Used

  • UWorld
  • USMLE-Rx

NBMEs Used

  • NBME 11
  • NBME 12
  • NBME 13
  • NBME 15
  • NBME 16 (most indicative)
  • NBME 17

*This post has been used with permission. (source)