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How I Scored a 263 on the USMLE Step 1

My students and peers often ask me: “How the heck did you score 263 on USMLE Step 1?”  My response is fairly simple: “I mastered USMLE World,” and here’s one way I did that.

We all know that the USMLE World Qbank is a commonly used resource for USMLE Step 1. It’s an excellent combination of a realistic test environment with questions that test high yield facts. In fact, sometimes these questions appear almost word for word on the actual exam! Almost all students use UWorld, but are they getting the most out of this wonderful resource?

Most students I work with score around 50% on their first pass through UWorld, which is a solid start. However, on their second pass through, these same students score between 65-75%. While this is an improvement, it is a little discouraging that even though you have seen the questions before you are missing 1 out of every 4 on your second pass through. (i.e., Fool me once, shame on you. Fool me twice, shame on me.)

When I was studying for this exam, I used a tool to help me learn from my first run-through of UWorld so I could score 90-100% on my second run-through. This tool was a UWorld Journal, and it’s one of the things that made my USMLE prep unique and definitely contributed to my success on the exam.

What is a UWorld Journal?

A UWorld Journal is a Microsoft Word (or Google) document you can make while doing UWorld. In question format (see below), it lists all the facts you did not know while doing questions, followed by the answer. Students should review the journal (similar to drilling flashcards), asking themselves the question and recalling the answer. This helps you learn the facts you didn’t know from UWorld so you don’t get them wrong ever again.

How Do You Make This Journal?

Step 1: Take a block of UWorld Questions.

Step 2: Create a Microsoft Word Document.

Step 3: Look over the UWorld Questions you missed and identify only the facts you needed to get the question right. For example, if the question was:

A 67 year-old man presents to your office with crushing chest pain radiating to the left arm. Troponins are positive and EKG shows elevations in leads II, III, and aVF. Which of the following is the most likely area of damage?

A) Pericardial sac
B) Anteroseptal myocardium
C) Inferior myocardium
D) Gastro-esophageal Junction

When I took this problem, I knew this was a heart attack (crushing chest pain radiating to the left arm with positive troponins). However, I did not know that leads II, III, aVF corresponded to the inferior surface of the heart. So, in my UWorld Journal I wrote (in bold):

What area of the heart is associated with leads II, III, and aVF?

Followed by (not in bold): Inferior aspect

As you can see, I only added the facts I didn’t know that were necessary to getting the question right. Although the UWorld answer to this problem had a long explanation of pericarditis, presentation of a myocardial infarction, and even a line about GERD, those facts were not needed to get the question right, so I avoided adding them into my journal. By focusing on the key point and keeping it simple, if this question came up again, I would never get it wrong.

Click here to see a few sample pages from my own UWorld Journal.

How Do I Review This Journal?

We suggest reviewing your UWorld journal either once a week or once every two weeks. When reviewing the questions, cover up the answers with your hand, ask yourself the question in bold, and then answer it. If you get it wrong, then highlight the question. Once you get to the end of the document, do all the highlighted questions again.

This is a cumulative journal, so every time you review it, review ALL the questions (even the ones from 5 weeks ago). This is a great way of 1) isolating the important information from UWorld, and 2) learning it so that you never miss the same question twice. This way, a 90%+ is a realistic possibility the second time you go through UWorld. Plus, you’ll have a better chance of recognizing similar questions that count on the exam.

Use the UWorld Journal with UWorld!

In my mind, no matter where you are in your studying, integrating a UWorld Journal with your UWorld questions could be the best way for you to get the most out of UWorld. It’s one way you can learn smarter than the rest of the crowd and distinguish yourself with your score. I know it’s one reason I scored high on this exam, so it’s definitely worth a try!