I failed this exam 5 years ago. It was the vignette.
This time I practiced multiple vignettes. (I was fortunate to have access to study materials from work, that I did not have 5 years ago)and very very fortunate because many people reviewed my vignette in this forum.
Also studied
Kaplan
Gave mock Kaplan and ballast (I think) practice exams...twice.
Thats it!