9 Common Mistakes You Can’t Afford to Make on Your USMLEs

  • /Reviewed by: Amy Rontal, MD
  • Dr. Brian RadvanskyDr. Emma Husain, and Dr. Eli Freiman contributed to this post.

    Think about the last time you were engaged in conversation, and your eyes and part of your attention drifted to read and respond to a text message while still paying enough attention to the speaker to engage in conversation. What would have been overtly rude not too long ago is now commonplace and expected. While we are becoming excellent multi-taskers, able to scan through one thing while entertaining another, we are becoming more and more distracted. Therefore, it is more imperative than it ever was before to maintain focus when focus is due. This is especially true when you are studying intensely for the USMLE Step 1 and 2 CK. Here are nine big mistakes that feel completely innocuous, but when looked at objectively, can definitely hamper your studying.

    9 Top Mistakes to Avoid When Studying for Your USMLEs:

    1. Granting yourself mini-rewards

    We’ve all been here. You complete your hour-long question block and are proud of yourself for pushing through. As a reward, why not a quick check of Facebook or the Reddit main page? After all, you’ve earned it, right? And a mental break will help your studying, no? But then you get sucked down a wormhole and find yourself reading Wikipedia pages about Charizard or Iwo Jima. Do we really care about these things? Or are we just searching for the dopamine rush of a liked picture or unexpected friend request?

    When it comes to your intensive studying period leading up to your exam (and throughout medical school, in fact), you should take measures to avoid these distractions.

    Answers to your question block should be reviewed immediately after completing the questions, while you are still inside your 100% medical mind, not while 15% of your brain is lamenting about there being too many pictures of babies on Instagram. After all, on test day, you will need to be focused and present for about eight straight hours — you might as well start building that stamina now. Sure, grab a drink, use the bathroom, but don’t lose energy and mind space to these time-sinks.


    2. Not setting yourself up for success

    As you progress through your clinical practice, you will learn the art of “setting yourself up for success.” Placing a difficult IV? Get yourself into a comfortable position with all the tools you need at your disposal, and the plugged-in ultrasound machine in a logical position. Pulling a chest tube? You want your patient in the optimal position, educated on their responsibility to exhale/hum/Valsalva on command, with your occlusive dressing within reach.

    The same art holds true for studying. Have your references (First Aid) and notepad close at hand, and close all other programs on your computer. Don’t carry on a G-chat conversation while studying! Set your phone to airplane mode, get your headphones on if you are in public, and shut the door to your office.


    3. Not striving to emulate test conditions (silence, timed, posture)

    Perhaps the most important thing you can do during your devoted pre-test studying is to emulate the actual test conditions. The closer your setup and environment is to the test center, the more natural Test Day will feel.

    Now I’m not suggesting that 100 percent of your studying be done alone at a desk; there is definite value to studying with others, getting outside, and seeing other humans during this often isolating time. But at the very least, you must spend a decent amount of time performing under the conditions you expect on test day. This means sitting with good posture and mental devotion at a desk, not doing all your question blocks on your iPad on the couch. Also, don’t get into the habit of only doing question blocks with music on—this can make the silence of the test center feel stifling.

    The biggest mistake I see students make is doing too great a proportion of their blocks on Timed Tutor mode instead of Timed. Don’t get me wrong, timed tutor mode is useful, but you shouldn’t get in the habit of expecting a green check or red X after every question. Plus, switching your mind from active question-answering mode to passive explanation-reading mode 44 times is radically different from the test environment, where you produce answers constantly for hours on end.


    4. Not letting the easy questions be easy

    Making easy questions more difficult than they are is a very common mistake that I’ve seen veteran studiers make all the time. We’ve all had multiple choice questions where we think, “It can’t possibly be this easy. I must be missing something.” So we think hard and in crazy directions to rationalize an equally crazy answer that is ultimately wrong. When we review the question we kick ourselves because it really was that easy and should have been a free point.

    Students do this because we never get over the expectation that board questions are supposed to feel really hard. This feeling persists despite hundreds of hours spent studying and makes very prepared students get simple questions wrong. Remember that the USMLE is not out to trick you. Prepared students should be confident enough to let the easy questions be easy and not get in their own way.


    5. Picking an answer choice simply because you don’t recognize it

    Picking unrecognized answer choices is something students do frequently when feeling defeated by a question. I call this mistake “raising the white flag.”

    Many students underestimate their knowledge and ability when it comes to answering questions. Thus, when faced with a question without a readily apparent answer, many students assume the answer must be something they’ve never learned and thus pick the unfamiliar answer. Ironically many of these questions are perfectly answerable and the student simply gives up too quickly.

    I tell my veteran students that if they’ve prepared right for the exam, they will rarely see questions where the correct answer is something they have never seen before. More likely it’s just a different approach to a common or easier concept. In these situations I urge students to go back to the stem as they have often skipped over or missed a certain key piece of information that suggests the more simple answer, and lo and behold they get it right!


    6. Changing answers without being able to explicitly explain why

    Changing answers is one of the more frustrating mistakes students see themselves making over and over. Many students make their way through a question stem piece by piece, logically thinking over each piece of information. They predict an answer and notice to their delight that it is in fact one of the answer choices.

    However, here’s where things go wrong: students feel the need to rule out every other answer choice. During this process of perusing the other choices, students encounter something that seems plausible and choose — without regard for their previous thinking — to switch their answer and ultimately get the question wrong. When I ask my students why they did that, they’re often left questioning the thinking themselves. The advice I give these students is not to change their answers unless they can explain to me explicitly why the new answer is better. This leads to more correct questions and higher scores!


    7. Confusing “increase” and “decrease”

    If a question asks “what would decrease” be sure that you don’t answer with what increased instead!


    8. Confusing “next step” with “overall solution”

    When reading questions, be sure you understand what is being asked. If a question asks for the “next step,” that is your focus! Not the overall solution to the problem.


    9. Confusing “complications” with the disease itself

    Don’t mix up the name of a disease with discussing the disease’s complications!

    How to Handle Strategic Mistakes When Answering Practice Questions

    Often, students will repeat the same type of mistake over and over again, to the extent that more than 20 questions are lost per practice NBME for one single, repeated mistake. More than 20 questions lost on an NBME correspond to about 30 questions on the real exam. A huge difference in score; in fact, a difference that months of study cannot overcome.

    Here’s a list of “double checks” for repeated mistakes as if you were writing them to yourself:

    • When I see an increase/decrease question I will highlight the word and write an up or down arrow on my scratch paper
    • When I see a management question I will verify whether they are asking for the next step or a later step
    • When I see a pathophysiology question I will verify EXACTLY WHAT THEY ARE ASKING THE PATHOPHYSIOLOGY OF
    • When being asked about the explanation of a symptom, I will CHECK MY ANSWER TO MAKE SURE I AM EXPLAINING THE SYMPTOM BEING ASKED

    You need to read this list before doing every practice question. Even if it means you have to do your first blocks of practice un-timed. Refer to the list before, during and after the question. Make sure you are respecting the recommendations on the list. Very soon, the list will become endogenous and you won’t need to look at it.

    When reviewing your questions, if you make the same mistake as one on your checklist, put a red mark next to it. If you make the same mistake tomorrow, put a blue mark next to it. Green the day after that. Be responsible for fewer mistakes of each type every day. And enjoy your extra 20-30 correctly answered questions!


    These small changes in your study habits can go a long way. While tiny distractions may not appear to be much of a hangup, they are definitely NOT helping you master the fund of knowledge necessary for your USMLE exams. It is crucial to be honest with yourself!

    If you truly want to excel, you have to take the measures to set yourself up for success. We’ve written before about the best lesson from a mentor—be 100 percent on when you are on, and 100 percent off when you are off. Give everything you have to working when you are working, and don’t think about it at all when you are relaxing. Let there be in-betweens. Real life distractions (family, sirens, hunger) will always exist, but do what it takes to maintain as much focus as possible, and you will benefit immensely.