The truths of succeeding on USMLE exams
When we first meet many of our students they say that test-taking anxiety is their main problem or the wording of questions confuses them; that their struggles on the test are not due to lack of content knowledge. But when we begin quizzing them on details, they just simply do not have enough specific knowledge to answer these highly-detailed USMLE questions. We have never had a student who consistently answered all of our questions under intense pressure not pass their exam, and those students who answer the most score highest.
Here is the key to answering a USMLE question: if there are six key bullet points for a medical condition/topic, ranked 1-6, you must learn them all. Each week, I have a student who finishes a USMLE exam and says to me, “I knew the first four key points, but they asked me some obscure fact.” (bullet point number number 5). Of course, at the beginning of your studies, it is a lot of work just to learn the top two bullet points on every condition, and that is your first task. But you will have to learn more esoteric facts. However, these tests are very difficult to pass if you simply memorize bullet points. So, in addition to the six bullet points, you must try to find 2 to 3 variations of questions on that topic. Yes, this is all a very difficult task. But this is the way you try to ensure that you will pass the test 10 out of 10 times or score high.
You may hear some teachers or videos tell you that ‘this topic or that topic’ is not important just because it is not on a self-assessment or in a review book. That is misleading. There are a lot of topics that students have related to us after taking a USMLE exam that have been asked five times or more that are not on self-assessments. There are a total of about 100 self-assessments for Step 1/2/3 and shelf exams. However, in the past 10 years alone, the USMLE has administered over 5000 USMLE exams, consisting of over 1 million questions. So you can safely assume that almost every fact has been tested, and you should approach your studying with this in mind.
Every fact and topic is potentially important. On test day, you may get an easy question on an esoteric topic that you can answer, versus a very difficult question on a common topic. And you need to answer both types. If you only learn the ‘bread and butter’ and ‘high yield’ topics for this test, that will barely get you to the 70% required to pass or get a high score. You must cushion your score with some more esoteric topics as well. If you say, “I’m not going to study embryology, histology, physiology equations, or other topics I’m uncomfortable with,” it will start to add up and put you in danger of not passing. I have met more than 20 students over the years who missed passing a major exam by one or two questions. So take every practice question you do very seriously.
There is a lot of randomness in the test because they have to make a new test for every day of the week. There have been tests given where there were no questions on lung or breast cancer, but two questions on neurocutaneous disorders or lysosomal storage diseases or a question on spleen embryology.
We have had students referred to us over the years with good knowledge who did not pass. Perhaps they got a bad test that day with many esoteric questions; if they took it 10 times they would have passed 9 out of 10 times, but perhaps the exam tested the 20% of knowledge the student did not know. Our job is to prepare you so that you have the best chance of passing 10 out of 10 times no matter what strange variation of the test you are given that day. We do not roll the dice with our students and their future.
USMLE exams are 50% knowledge and 50% confidence, physical stamina, and test-taking technique.
How to actually put the material in — and keep it there — before test day.
The tutoring sessions and lectures we present to prepare you for USMLE exams are different than those for medical school or what you might watch online. There is not time for full lectures on each subject; you will never get through the material.
Students frequently ask: “Why can’t I remember all this information? What’s the key to retaining it?” The best way to retain it will be a combination of reading the material, seeing it visually in diagrams, listening to audio recordings, doing questions, and being intensely quizzed on it for active learning. Some of these modalities work better for certain learning styles, but in most cases a combination of several modalities is most effective.
All students should utilize some kind of flashcard deck for efficient, high-volume fact input.
There is a collection of over 10,000 actual USMLE questions from Step 1 assessments, shelf exams, Step 2, and Step 3. We always urge our students to try to complete these USMLE questions first to get a sense of the test writers’ terminology and emphasis of test topics. This is in addition to completing a commercial question bank, where you can search for questions on specific topics.
Students ask me every day: “How should I split my study time? Should I spend 50% of my time memorizing facts/reading content and 50% of my time doing questions?” There is no right or wrong answer to this. It is a personal thing. I will say that if my students are short on time, I do advise they focus on questions to attempt to get their content from the questions as well as to improve their speed and technique of answering questions.
The questions and the descriptive terms of diseases we use will not come from review books. This is why USMLE questions sound confusing: students are used to the bullet points from review book sources, but the USMLE is drawing on descriptions from textbooks like pathology books. So descriptive terms do not sound like the information you have reviewed.
When studying pharmacology, make sure you learn individual drug names as well as the class of drugs. And for every drug, make sure you know its mechanism of action, drug side effects, contraindications, alternative drugs (ex., if you have a sulfa allergy), indications for the drug, and if it is an antimicrobial, how the infectious agent gets resistant to the drug.
When learning disease names, make sure to learn the acronym of the disease name as well as a technical name (ex., Hasimoto’s disease or chronic lymphocytic thyroiditis).
Turning what you know into correct answers under pressure.
Many of our students will say, “I can’t tell you the answer, but I’d recognize it if I saw it as an answer choice.” However, if you do know the answer without looking at the answer choices, it will save you time, and test writers have a way of changing the description of the answer so that you do not recognize it. The students we work with who have the most success on these exams can recall the information when we press them or present new variations on questions.
It is important to be systematic when you work through a USMLE question. Be efficient at highlighting key info and crossing out answer choices that you know are impossible. This will give you a better sense of control over the questions and make them seem smaller on the screen.
We will work with you on the process of eliminating answer choices until you are left with the best option, and perhaps you do not recognize or understand that answer but it is the only one that makes sense.
There are many techniques that people try to use to answer USMLE questions. Some students like to read the last line to know what they are asking or look at the answer choices and then go back and read the question having a better sense of what is to come. It does not work for all of our students and some prefer to start reading the question from the beginning. This is a personal decision and that is why it is important to do thousands of questions and trial and error until you find what works for you.
I always instruct my students that if you come to a question and you do not like the look of it, move on and come back to it at the end. Make sure you get to the questions that you are able to answer. If you do start a question and invest time, finish the question. Do not have it on your mind as you move forward in the test. And by the time you come back to it, you will probably have forgotten what it was about anyway.
Changing answers is a common issue among students, but over time, as you review the material more than one time, you will begin to trust that inner voice that urged you to pick the first answer.
Students are now used to having an electronic device at their fingertips if they do not know the answer to something, and they do not really force their brain to remember the information. This leads to insecurity on test day when they cannot lean on this crutch. It takes training to develop a good memory, especially when you are under pressure, and you must force yourself to try to recall and to develop good strategies if you cannot.
Preparing the person, not just the knowledge. The half of the exam that isn't recall.
Another common problem we encounter is that students are too relaxed at home during their preparations and never put themselves under stress. The first time they feel stress is on test day. But it is important to feel some stress and pressure before the real exam, to become desensitized, and we hope to give you just the right amount of that.
I also recommend that my students take some form of a full-length exam before they take Step 1/2/3. This may require stacking two Step assessments back-to-back so they can gauge how their stamina is and what improvements they need to make.
We urge you to close your books during the sessions and to force yourself to concentrate and follow the questions. This will help discipline your mind and hone your concentration. Test day can be disorienting, where you lose your focus and misinterpret questions.
Before each tutoring or lecture session, prepare yourself like you are taking the real exam, and try to anticipate tangents that we may ask. USMLE questions often start on one topic and go in a completely different direction and you must anticipate that, and our sessions will prepare you for that.
If your goal is to get an extremely high score on these USMLE exams, explore every modality that may assist you. Be open minded and willing to add new techniques to your regimen that will let you peak on test day.
In the weeks proceeding your exam, keep your daily regimen the same: the food you eat, your study and sleep schedule, your exercise routine. Try to avoid crowded events like clubs, sporting events, and concerts where you might catch an illness.
If you find yourself getting burned out or stagnant in your studies, try to visualize the future reward for all your hard work: that you will have a great life and rewarding career helping people.