It’s a common plateau for USMLE test takers: “I always get it down to two and then I pick the wrong one!!”

The good news is, narrowing the answers to two remaining choices means you are on your way. You eliminated the obviously incorrect answer choices and in order to do that you probably had some idea of what was going on in the clinical scenario and question.

At this point many students randomly just pick — DON’T DO THIS. You worked so hard to narrow it down; let’s finish the job and get the point!

Some Steps to Take to Avoid the “Distractor” Answer

Different tutors may have different suggestions for how to tackle split decision moments, but it is imperative that you have some kind of protocol for these kinds of situations as you will likely come across them many times in your USMLEs.

If you don’t already have a tried and true method, I’d suggest considering this approach:

1. Look at the two choices. Ask yourself, “What is the difference between them?” For example: If your choices are hemochromatosis and Addison’s disease, you could say, “Hemochromatosis causes diabetes which would have high glucose; Addison’s is a lack of cortisol, so there would be low glucose.”

2. Look in the scenario for the differences you described. You may be immediately successful, which means you can select your answer confidently and move on to the next question.

3. If you still cannot choose, look at the question stem: Are there keywords like “next step,” “directly,” “most rapidly,” or “most severe”? Use those words to see if one answer choice is better described by the keywords.

4. If all of the above fails, MOVE ON. You can’t spend any more time on this question. Pick one of your answers, mark the question, and if you have time, you can come back to the question.

Here’s Where Working Harder IS Working Smarter

Working harder when you are down to two possible answer choices can often yield a surprising and sudden jump in correct answers. This is because many students study to this point and then get stuck. Leaping over this hurdle is satisfying and rewarding, so do that extra little bit of work when you’re down to two, and you should start seeing some marked improvements!

Also, don’t forget to trust your gut. If you know that you ALWAYS go back and change your answers to the incorrect option after talking yourself out of your initial (sound) reasoning, start addressing this tendency early on in your studies.

Force yourself to be aware of the times when you’re going against your gut instinct—particularly when you’re working through question blocks in USMLE World or taking an NBME. If you make yourself stick with the initial answer you chose and then see if your instinct is leading you in the right direction, this too will only further help you score high come test day.