#board prep

Y'all, I'm sitting here with my RN license in hand, and I had to share this because six months ago I was literally crying in my car after bombing another practice test. Like, ugly crying. The kind where you question every life choice that led you to nursing school.

I had tried everything. Flashcards? Check. Question banks? Double check. Review books that cost more than my textbooks? Triple check. But my scores were stuck in this frustrating 60-65% range, and I was starting to panic because my NCLEX date was creeping up fast.

The Problem With How I Was Studying

Here's the thing I finally realized: I was studying nursing like I studied for every other test in college. Memorizing facts, drilling questions, hoping something would stick. But the NCLEX isn't testing if you memorized that normal sodium levels are 135-145 mEq/L (though yes, you should know that). It's testing if you can think like a nurse.

And thinking like a nurse means seeing the whole picture, not just isolated facts.

The Method That Actually Worked

I started what I call "scenario-based learning," and it completely changed my game. Instead of just answering random questions, I began working through complete clinical scenarios from start to finish. Like, really detailed ones where I had to think through:

What's happening with this patient right now?

What could go wrong?

What's my priority?

What would I do first, second, third?

How would I know if my interventions worked?

It was like the difference between learning vocabulary words versus having actual conversations in a foreign language. Suddenly, all those random facts started connecting into actual clinical reasoning.

I found this tool called Case Crafter Pro that generates realistic clinical scenarios using AI, and honestly? Game changer. Instead of the same recycled cases everyone uses, I could practice with fresh scenarios that felt like real patients I might actually encounter.

How I Actually Did It

Step 1: Start with the big picture I'd read through the entire scenario first without looking at any questions. What's the story here? What kind of patient am I dealing with?

Step 2: Think out loud This felt weird at first, but I literally talked through my thought process. "Okay, this patient has chest pain and shortness of breath, they're 65 with a history of hypertension... I'm thinking cardiac, but I need to rule out..."

Step 3: Work through priorities Before jumping to interventions, I'd force myself to identify what's most important right now. ABCs? Safety? Pain? This helped me nail those priority questions that used to trip me up.

Step 4: Follow the whole case Instead of just answering one question and moving on, I'd follow scenarios from admission to discharge when possible. How does this patient's condition change? What complications arise?

The Results

Within three weeks of switching to this method, my practice scores jumped to the high 70s. More importantly, I felt confident. When I sat for my NCLEX, I wasn't just recalling facts—I was actually thinking through each scenario like I'd done hundreds of times in practice.

The computer shut off at 75 questions (hello, anxiety), but I knew I had passed before I even got the official results. That clinical reasoning muscle I'd built up made all the difference.

Why This Works

The NCLEX isn't really testing your textbook knowledge—it's testing your ability to apply that knowledge in real situations. When you practice with complete clinical scenarios instead of isolated questions, you're training your brain to make those connections automatically.

Plus, it makes studying way more interesting. Instead of mindlessly drilling questions, you're solving puzzles and telling stories. It actually feels like preparing to be a nurse, not just preparing for a test.

If you're stuck in that same cycle I was—knowing the material but not seeing the scores you want—try shifting to scenario-based practice. Case Crafter Pro has been incredible for generating the kind of realistic, detailed cases that actually prepare you for both the NCLEX and real nursing practice.

attn end-users of Qbanks: Please do not start your question feedback with “According to First Aid/DIT/UWorld/OnlineMedEd” as we don’t really give a shit what other board prep materials say.

However, a citation from something like UpToDate is appreciated and helpful in addressing your concerns.

thanks,

Hey there everyone! I’m gonna do my best to start writing again, now that boards are over. I also wanted to just let everyone know the YouTube will be back up and running in no time but I had a tonsillectomy complicated by 4 trips back to the OR!!! As a result, my ability to speak is currently quite limited, but as that returns, so will the videos.

Let me start with a short preface. I am not going to post my boards scores but to give you some “benchmark” on why you would or wouldn't want to trust me, here’s this: This post is targeted at the students who want to break 230 comfortably, be above average etc. I cannot say that this is the advice that will get you above a 245... but that said, I'm sure some of this advice will still work for anyone. As for a COMLEX benchmark, I would say to you keep reading if you are interested in breaking 600 quite comfortably. Again, I’m not guaranteeing scores or flaunting mine, but I feel it would be helpful for you to have an idea of who is writing to you.

So without further ado, what do you need to know, to start second year strong?

1. Mental Health is key. I cannot stress this enough, the old adage you cannot take care of others without taking care of yourself has never been so true. additionally, if you are not in the right mindset for second year, you will not succeed. In my opinion, the best way to approach second year is a challenge that you are excited to tackle and grow from. The biggest “wall” in most students mind isn't the coursework, but the exam at the end of the year. You will start hearing students talk about how they “aren't doing class anymore” or “I just reading first aid” and to me that B.S. Your classes second year are incredibly high yield. They essentially contain the material you are going to see on boards. The more work you put in second year, the more you are going to get out. You need to keep that mindset because it is easy to fall into the trap of “oh I will just study for boards”. Please don't be that guy or gal, just study like you actually want to learn medicine and I promise the scores will follow. This leads me to #2.

2. Boards are not the MCAT, they are not a beast, they are not unfair. You will hear a ton of folks talking about how they are bad at standardized tests, they didn't do well on the MCAT, they don't think boards focus on real medicine, this list goes on. I truly believe all of the above don't matter. Let me first address the content issue. The content on boards IS medicine. It is again, B.S, when people say its irrelevant or its unnecessary information. Now, USMLE is more guilty of random useless detail than COMLEX, but the truth is at the end of the day, MOST of what you will see is normal medical questions. The detailed questions are there because everyone knows the basics, that is for you to show that you are above average because you have worked so hard to get to this point. 

Okay that aside, lets address the MCAT thingy. So there is this AAMC stat that gets tossed around all the time about MCAT score correlating to boards exams. The truth is, if you had life figured out and were a great student when you took the MCAT, then I’m sure that stat holds up. That said, I was not, and as you may recall, I had a 26 on my MCAT... This should have been roughly a low 200 on USMLE... I can confirm that I was no where near this. Don't let statistics define you, each time you take a test like this, it is a new experience and you define your future. Remember there are always statistical outliers... be that outlier!

3. Work Hard. Sounds silly right? Just don't forget what you are there to do. This is a long and grueling road, and you can easily lose focus for numerous reasons. Just remind yourself why you are in med school and what this means to you. That will be different for everyone but hopefully that will help you to dig deep and find what you need to push on. 

Alright, I think that should be sufficient to start you all off in the right mindset for your 2nd year. This applies to a good mindset for first year as well! Look out for the YouTube, I am planning videos talking about how best to utilize Step 1 with your coursework as well as how to get the most out of UWorld. 

Until next time,

thepre-medlife

Twitter: thepre_medlife

I almost answered this based on COMLEX 3, when I realized you’re probably talking about the earlier parts. I had written this stuff about how the CDM cases are stupid.

Anyway, I’m not gonna lie to you. The first of these exams carries a good amount of weight. When it comes to getting your foot in the door, nothing kicks harder than a high Step 1/Level 1 score. It’s stupid because it’s mostly testing pre-clinical knowledge but I guess that’s what makes it the hardest, and allows programs to separate candidates out.

Modify your board prep schedule based on how you learn (and that’s assuming you would benefit from a fixed schedule at all). You can find thousands of study plans floating around and it’s great to steal pieces from those, but in the end this is about building a bridge that you can cross to get to a good score.

I learn by facing a clinical situation repeatedly and with each exposure a little more is committed to memory, so the Qbanking makes sense. And I seldom did any full-length self-assessments. My attention span catered to blocks of 10-15 questions at a time, then going back to review the material of those questions. Lots of short breaks to digest. Most Qbanks come with basic stats so you can still see how you’re doing overall.

Not everyone is like that. Other people live and die by First Aid. Any book-based prep was not for me, and outside of a few pages I never used it.

What I Learned While Studying for Step 1 #boardprep #UWorld #COMLEX #USMLE #Step1 #firstaid

What I Learned While Studying for Step 1 

by Guest Blogger Valerie of  https://tobeacountrydoc.blogspot.com

 Hey All! I hope that summer has found you and you are taking time to enjoy this lovely weather! It finally is getting above 60 where I live and I could not be more excited! If any of you follow my blog you may notice that I have been absent. Very absent. Perhaps you thought I had…

I was pretty happy with what I did, just wish I could have been a little more focused. I put a lot of my effort into doing/reviewing practice questions and watching videos (OnlineMedEd, Pathoma, random YouTubes). Goljan audio is very portable, so I’d recommend that too.

But bear in mind that everyone learns differently. I used the videos/audio because the explanations were SO good, but I did the questions because they kept me engaged. I don’t learn as well from pure reading (I made little use of First Aid except as a reference).

All that being said, my score could have been a little higher. I think I burned out for a little bit and stopped putting stock into my review of questions. Probably something I’ll keep an eye on this time around.

Stress is pretty par for the course in the first round of board prep. Try to find good coping strategies and slow down if you need to. It’s better to get a good understanding slowly than to cram a bunch of shit in only to have it fall right back out. I was guilty of that on some topics because I just didn’t find them clinically relevant.

I didn’t take USMLE Step 1, and while I toyed with taking Step 2 I don’t think it’s going to be necessary for me. There are some MD programs I’m interested in but they take COMLEX scores, and even then I’m not sure I’m willing to skip the DO match to wait for them. On the other hand, I’m definitely checking out the dually-accredited programs.

I was fine with my COMLEX score, but would have been a little happier had it been 50 points higher. I’m going to blame it on the poor morning nutrition and inability to sleep the night before... make sure you grab some solid eats. It’s a long climb to lunch.

It doesn’t look like my score is going to hold me back. Of the programs I’ve contacted for auditions so far, only one has given me a minimum score higher than mine. While I’m pretty anxious about the process of scheduling, I’m pretty confident I’ll be happy with the news I get on match day.