So I finally took my step 1 yesterday and it went well 7amdilah.
Since the trend is to share one's experience, I'll do my best to mention both general and personal concepts. For the most part Mohammed Shareef and Mohanad Abusaleh wrote the main important points you need to know. Hani AlTurkmani is also a master on this topic. All 3 of them really helped me out. I didn't realize I wrote so much but hopefully it helps.
• First of all, yes, this exam is tough, there's no getting around that, but finishing it will make you a MUCH better physician and it WILL reap rewards in your clinical life and separate you from those who didn't take it. It looks really good on your CV too as it's globally acknowledged. The practicing in the US part is a given.
• Set your target grade and work to achieve it. Ideally, and personally I think everyone should, aim for ABOVE average (above 225). Doing so really goes a long way as a lot of elite or tier 1 hospitals filter applicants that way.
• First Aid must be studied and reviewed cover to cover at least 3 times. It's an extremely concentrated book and each word is there for a reason. Get the latest edition for the year you're taking it in and check their website for errata (really minimal usually)
• USMLE world question bank is absolutely essential. Get used to doing random timed blocks early on. The more you do the more you'll get used to the real thing.
• Take an NBME(s) online to asses yourself. Take it at least one month before to know objectively where your weaknesses are and have time to fix them.
• Avoid the temptation of reviewing the same material or info that you already know when you get closer to the exam. Review weak points you know you're deficient in.
• There's 46 questions per block and 1 hour to finish them in. Technically, you have 77 seconds per questions, so manage your time VERY well. This is a must. I did it by aiming to finish each question in 60 seconds so I know where I am on the clock and to add the remaining 17 seconds onto more difficult questions.
• Personally speaking, the exam was harder than I expected and some questions were as hard as USMLE world. That being said, it's doable but intimidating at first.
• By far the majority of the exam is Pathology (systems) and rightfully so. I'd say around 60 to 70% of the exam. Do NOT take shortcuts studying pathology. Make sure you know it very clearly (Goljan and Pathoma are the top two books for this)
• Understand CONCEPTS not just blindly memorize. Yes, some info you need to memorize of course, but by far they care about the MECHANISM of diseases and "why" or "how" they work. They assume you know the "what" and want you to put it to get use in a clinical situation. Some questions are just pure memorization though...some.
• Remember, some questions are "experimental". This means that they are researching these questions to see if they're suitable for future exams. These questions, as far as I know (I could be wrong) do NOT count whether you got them right or wrong.
• Definitely expect roughly 5 questions per block you've never seen before or know anything about. Don't be intimidated and just give it your best
• You should have the step 1 completed before your internship ends. Even better if before you finish med school. During residency it will be extremely difficult to do so and you'll want to take step 2 or the Canadian exam then. Taking step 1 will really help when you take step 2 after, but personally I don't think the other way around will help much.
• A HUGE factor in this exam is anxiety and frustration. Understand that it is first and foremost an ENDURANCE test! Learn to be patient during studying and the exam and keep calm. It's very easy to get flustered and get mind blocks. It's 7 long hours and I tended to get eye twitching and brief absence seizures for a few seconds at the last blocks lol. Again the more randomly timed blocks you do before (in one sitting) the better. It'll keep your breath held for a lot longer. Trust me when I say it is an ENDURANCE test.
• Memorize lab values the last day and save time on questions (easier than you think)
• Keep in mind this test is VERY subjective and that everyone explaining it is basically
stereotyping. However, the cumulative input from multiple sources is what will give you the best idea. Again, the only constant is PATHOLOGY