Return to Blog Homepage

USMLE Prep Mailbag: Round Two

With the USMLE rapidly approaching, we are back for round number two of the USMLE Prep Mailbag.

For some of our earlier questions, please see the previous post.

Otherwise, let’s see what our readers and students are asking and help you all achieve your best possible score.

Help! I’m getting burnt out. What should I do?

Keep pushing! Burnout is a very real issue that we all face during our test preparation. The most important thing is to realize that you’ve already come so far and that you’ll never regret working a little harder for a little bit longer. With that said, there are some important points you can consider:

1. Should I consider moving up my test? Maybe you overestimated how much time you would need to study and are already scoring near your target on your NBMEs. If you’re getting burnt out because you’ve just been studying too long and feel confident that you’re at or near your target score, you can always consider moving your test up if it’s more than 10-14 days away.

2. Should I take a day off? Maybe. It really depends on how much time you have left and how well you are doing. If you only have 4-5 days to go, I would encourage you to just push through it. However, if your performance has been strong and you still have several weeks until your test, you could definitely consider taking at least a half-day off from your studies. Go to the pool, see a movie, or have dinner with some friends; a little break could definitely recharge your batteries.

3. What about having a balanced life? It is very easy to make the USMLE your entire life from breakfast to bedtime. However, the best way to combat burnout is to make sure you are living a healthy and balanced lifestyle while studying. Go to the gym. Avoid fast food. Talk with your family. Take some time to just relax at the end of the day. I am a huge basketball fan and when I was studying for Step 1 during the 2010 NBA playoffs, I always made sure to end my day by watching at least half of a game. This consistently gave me something to look forward to.

I’m struggling with Immunology and Biochemistry and only have four days until my test. Any advice?

In my experience as a tutor, many students will have ongoing struggles with biochemistry and immunology. These are very detailed sections requiring both memorization and application of key concepts. Thus, the best strategy for doing well on these sections is to start studying early and make sure you’re incorporating repetitions on these topics multiple times each week.

However, if time is running out, there are some very high yield topics that a smart studier could focus on to maximize their score if they’re struggling in these areas. Considering that neither of these two areas make for a very high percentage of your USMLE score, I would never advise solely focusing on them  instead, you can turn your attention to some high yield topics within them and supplement your reading with recurring passes through these areas on your question bank. Those high yield areas are:


1. Immunodeficiencies  Wiskott Aldrich, SCIDs, IgA deficiency, Chediak-Higashi, Leukocyte Adhesion Deficiency, Chronic Granulomatous Disease, and DiGeorge Syndrome.
2. Transplant Rejection
3. Hypersensitivity Reactions
4. Autoantibodies
5. Immunosuppressants


1. Genetic Diseases
2. Inborn Errors of Metabolism
3. Nutrition  vitamin deficiencies and excess
4. Lysosomal Storage Disorders
5. Glycogen storage disorders

Students who just know these areas very well can definitely do well on these sections.

I’ve completed my first pass through USMLE World — should I reset my question bank, just do incorrect questions, or purchase a second Qbank?

The best answer is that it depends on several factors including how well you did with your first pass, how much time you have remaining, and your ability to learn from a question that you’ve already seen.

I personally think that a second pass through USMLE World is superior to switching to the Kaplan Q bank (the second best question bank, in my opinion). However, if you’re someone who easily memorizes the answer choices and is finding that this is hindering you from working on your test taking strategy, then it’s definitely worth switching question banks (especially if you need to work on issues with timing). A new question bank can challenge your test taking skills and introduce you to new ways of testing the same material or even new concepts that weren’t addressed in UWorld. However, if you did very poorly during your first pass through UWorld, I would recommend continuing to at least use your incorrect questions even if switching to Kaplan.

If you’re going to continue by only using UWorld, then I think how you use it really depends on the amount of time you have remaining. For students with greater than 3 weeks until their test, I would always recommend resetting the question bank and trying to go through each question again. Your second pass will always be quicker and you should be balancing your study schedule to include more questions and less reading as you get closer to your test. However, if you have less than 3 weeks, I would recommend working through your incorrect questions and continuing to do both mixed blocks and subject-specific questions from the entire pool of available questions.

I’m struggling with Microbiology and Pharmacology. Should I use another resource?

Probably not. This is another common question that I encounter in emails and when meeting with my students. However, my experience has taught me that regardless of your baseline level of knowledge, the information in First Aid and UWorld is more than enough to do well on these sections. Chances are, adding an additional resource is just going to complicate your studying by stretching your efforts thin and exposing you to material that is not high yield for your exam.

Instead, you should focus on how you’re approaching this material. Remember, these are memorization sections, so repetition is key. If you’re not already, and have the time, consider making high yield flashcards for each drug and bacteria/fungus/virus. If you struggle with creating flashcards, consider spending $99 and purchasing the ones available on Memorang. Once you have your flashcards, set aside 1-2 hours a day for ongoing repetitions. The more times you see this material, the more your score will rise.

The first three times they tried to open Jurassic Park, it ended in complete disaster. Why would they open it again?

I have no idea. The financial aspects and management planning of a dinosaur theme park are definitely over my head.

My next rotation starts in two weeks, but I don’t feel ready for Step 2 CK — what should I do?

Before making a decision, you should ask yourself a few questions: if I took the test in two weeks, what score would I probably get? How far off from my target score am I? How did I do on Step 1?

If you did poorly on Step 1 and are using Step 2 as a way to strengthen your application for a competitive field, I would argue that you should consider pushing your exam back as another poor performance could significantly hinder your application. I understand that a lot of these rotations are also important for letters of recommendation, but I would argue that a strong USMLE performance is even more important.

Also, consider how far from your target score you actually are. If you are only 10-15 points off, you may be able to address these issues over the span of the next few weeks. Consider working with a tutor to determine where you should focus your efforts to maximize your strengths and improve on any weaknesses.

It’s the day before my test, what should I do?

Relax. You’ve finally made it to the finish line. I typically tell my students to spend no more than 5-6 hours going through some last minute review. If you’re taking Step 1, the end of First Aid has some high yield review that covers many buzzwords and all of the formulas you need to know. This could be worth a lot of points on your exam. You can also go through some of your incorrect and marked UWorld questions to refresh yourself on certain topics.

Regardless, you should stop studying by no later than 4-5 pm. Print out the necessary materials for your exam, enjoy a nice dinner, and relax with the confidence that you can do well. Make sure to get a good night of sleep but try to avoid any sedating medications unless you give yourself at least 12 hours for their effects to wear off; you don’t want to wake up groggy on the morning of your exam.

Stay tuned for more advice!