USMLE Preparation Mailbag: Your Questions Answered

  • /Reviewed by: Amy Rontal, MD
  • usps_truck

    Whether it’s from students I work with on the wards, tutor, or who read my blog posts, I’m always getting a lot of really great questions about USMLE preparation and the test taking strategies that are necessary to ensure your success on any of your medical school exams. Today, I wanted to take the time to address some of these questions.

    Should I memorize the normal values for all of the lab findings?

    Absolutely! As I’ve stated in a previous blog post, you will need to AVERAGE 65-71 seconds per question in order to finish each block with 10-5 minutes to review, respectively. Wasting time struggling to scroll through lab values and assess every CBC and BMP given to you will start to eat away at your time very quickly.

    Just as a practicing physician should know the reference ranges for common lab findings, so should a successful test taker. Focus on memorizing the most common lab values first (Na, K, Hgb, WBC, Platelets, PCO2, HCO3, etc.) and then worry about memorizing the other lab findings. As you’re going through your question bank, test yourself and see if you can interpret the labs without using the reference chart.

    How many UWorld questions should I do a day?

    Unfortunately there’s no correct answer for this one. How many questions a student should do each day is a fluctuating number that must account for where you are in your given study plan. In general, I encourage all of my students to get through USMLE World two times (if that is not possible, to get through at least once with enough time left over to review all of their incorrect questions).

    The Step 1 UWorld Qbank has a total of 2244 questions. So, for an eight-week study schedule, you would need to AVERAGE 80 questions per day in order to complete the question bank twice. However, that doesn’t mean you should start off doing 80 questions per day. Early in your study period, you will need to focus on quality over quantity ensuring that you are maximizing the value of each question and efficiently working through the blocks you have laid out for the day. As your test approaches, you’ll find that you can spend less time reading and more time working through questions during your day.

    I’m not very good at                   , so should I just put those practice questions off until closer to my test?

    Absolutely not! Going in to my Step 1 studying, I was terrible at biochemistry. I hadn’t seen it since my first year of medical school, and even then I really struggled to make it click. For the first week of doing UWorld questions, I missed nearly every biochemistry question I encountered. And while I thought about pushing the questions off until I knew the material better, I realized that learning from the questions was a way to master the material.

    Ask yourself, “What do I NOT want to see on my test?” and then start addressing that subject or subjects as early as possible. The more repetition you have, the more your performance will improve. And as you’re going through the UWorld questions, rather than becoming frustrated at what you don’t know, commit yourself to learning from EVERY question and not moving on until you fully understand that explanation.

    How did you feel about the Packers losing to the Seahawks in the NFC Championship?

    Well that’s just mean. Has significant time passed since then? Yes. Was it one of the most heartbreaking, horrible days of my life? Did I not watch ESPN for about a week after? Did I defriend all of my Seahawks friends on Facebook after? I think I’ve developed some retrograde amnesia for that game and have moved on to preparing for my inevitable heartbreak when Oklahoma City doesn’t win the NBA title this year and Kevin Durant leaves to go play for the Wizards. Sports are the worst.

    I did poorly on Step 1, so when should I take Step 2 CK?

    Early. If you’ve done poorly on Step 1, you should view Step 2 CK as an opportunity to improve your residency application and highlight your academic strengths. Competitive programs may be willing to overlook a poor Step 1 score, but you will need to have a strong performance on Step 2 in order to show that you’ve made significant improvement.

    Consider taking Step 2 very early during your fourth year and potentially taking a month off of rotations to focus solely on preparing for your exam. This way, you’ll have a score in prior to submitting your application on ERAS and can focus on your clinical rotations when you’re doing visiting rotations or Sub-I’s.

    I did well on Step 1, so when should I take Step 2 CK?

    It depends. The old school wisdom was that the better you did on Step 1, the later you should take Step 2. However, as the residency match has become more competitive and Step 1 averages have trended upward, having a strong Step 2 CK score available when you submit your ERAS has become ever more important. Before you put off Step 2, be sure to check the websites of the programs you plan to apply to as many residencies now require Step 2 scores to be available before they offer anyone interviews. Additionally, make sure to talk with some program directors and advisors at your school to see how competitive your application is compared to the level of competition for your desired specialty.

    Should I use flashcards?

    Probably. My experience with the USMLE has shown me that subjects like Pharmacology, Microbiology, and Immunology are killable topics. Meaning if you put the time in to memorize them, you will do very well on those sections of your test. Using flashcards, particularly through online software that uses spaced repetition, will ensure that you are getting constant high yield repetition of this material and can help you maximize your score.

    I generally recommend making your own flashcards as this ensures that all of the material you need is covered and it helps you to learn the material as you are creating your cards. However, for students who have never made flashcards before or who have limited amounts of time to study, programs like Memorang, Firecracker, and Quizlet do have good pre-made options.

    Do I need the most up-to-date version of First Aid?

    Absolutely! Students commonly ask me how much difference exists between the 2014 and 2015 versions of First Aid for Step 1. And while most of the subject material is the same, the newer version has the most up-to-date listing of drugs that may be tested on the exam and reflects any new trends on the USMLE from previous years. You wouldn’t drink expired milk — so don’t study from an expired resource!

    That’s it for today! Be sure to check back in for more mailbag responses and please feel free to submit even more questions for me to answer. In my next post, I’ll answer questions on how and when to adjust your study plan, using NBMEs, and when to consider pushing your test back.