USMLE scores are an important component of any residency application and students are constantly searching for the latest resource or study hack that will help them score better faster. While certain resources may be more helpful than others and productivity is important, the truth of the matter is that scoring well on these exams requires hard work more than anything else.
What Goes into a Strong USMLE Score?
The official USMLE website has content outlines and specifications for each subject of the exam that change slightly from year to year. The pie chart below shows a rough outline of how each topic area contributes to your score with the pieces of the pie summing to 100%.
There is one major problem with the above chart. It doesn’t tell the whole story. Performing well on your USMLE exam is not as simple as knowing the subjects in the pie chart. You also have to know how to use that knowledge to answer questions correctly on the exam. The ability to implement what you know or make educated guesses is part of your test-taking strategy.
I estimate that roughly 80% of your score on USMLE exams will come down to your content knowledge or how well you know the material. That is obviously most of your score but I feel the other 20% comes down to test taking strategy and your ability to apply the information you do know in a rational and organized fashion. Another highly experienced tutor estimated that up to half of all missed questions stem from an error in something other than content knowledge. If you consider that the average on UWorld is 63%, that means 37% of questions were missed. Half of 37% would be 18.5% which comes out very close to my estimate of 20%. That is a massive percentage that most students are completely ignoring! The real pie chart looks like the one below.
What is Test Taking Strategy?
Even if your medical school didn’t explicitly cover it, almost every medical student has been exposed to test-taking strategy in some way, shape or form. We all remember the student in high school or undergrad who always scored well on exams despite studying less than everyone else. You may not have realized it at the time, but much of his or her success was probably due to test-taking strategy instead of a photographic memory. All exams are different but tests operate by certain rules and question writers follow certain patterns. If you can figure out the rules for USMLE exams and how question writers operate, then you can understand the exam better and act in accordance with those rules/principles.
Test-taking strategy, as it relates to USMLE exams, is using proven techniques and logical approaches that methodically improve your chances of performing well on your USMLE exams. Test-taking strategy can be split into two categories. The first has to do with how you study in preparation for your USMLE exams while the second has to do with the method you utilize to work through the exam (and practice questions).
How Should You Study for USMLE Exams?
When it comes to studying for USMLE exams, there are a number of important things to consider including resources, schedules, question banks, and practice tests. If you need help with any of these topics, I recommend you consider purchasing Step 101 which discusses each of these topics in great detail. For now, we will focus on the physical act of studying and how you can improve that after you have made decisions on the each of the topics listed above. There are several important concepts including spaced repetition and interleaving practice that can help you study for USMLE exams more efficiently.
Spaced Repetition
Spaced repetition involves repeated exposures to material over the course of time to help reduce forgetting. This is based off of studies that have demonstrated how we forget information over time following the forgetting curve pictured below.
Image: https://www.mindtools.com/a9wjrjw/ebbinghauss-forgetting-curve
Spaced repetition interrupts this process and repeats exposure to material before you can start forgetting it. Very few students come in to medical school using this approach as most are used to massed practice and cramming. Anki is a popular flashcard resource that automates the practice of spaced repetition.
Interleaving Practice
Interleaving practice involves intentionally introducing variety into what and how you study. Many students tend to reread their notes over and over in an attempt to burn the information into their brain. The evidence suggests that this is not particularly effective. Instead, students should spend one day rereading notes, another day working practice questions and another day going through clinical cases that involve specific topics. This variety provides for an understanding of the concept that is both broader and deeper. In other words, you understand the subject better, but you also understand how it relates to other subjects better.
Interleaving practice can involve how you study (noted above) but it can also be applied to what you study. Students tend to prefer studying subjects in blocks for extended periods of time. For example, it’s common for medical students to spend several hours Monday studying all things cardiology and then several hours Tuesday studying pulmonology and then Nephrology for several hours on Wednesday. It would be better to study each of those three subjects for one hour per day on three consecutive days. This same principle can be extended over weeks so that the topic you take practice questions over a given topic a week after you have covered that particular subject in Pathoma. Below is an example of how you could set up your schedule using this principle.
Note: This would make most sense for someone trying to prepare for USMLE exams during a prededicated study period before beginning dedicated studies.
Once you’ve figured out how to study for USMLE exams, it’s time focus on how you can hone your approach on actual test questions.
How Should You Approach a USMLE Question?
The goal with USMLE questions is simple: You want to get as many right as you are capable of. Everyone’s capability will be slightly different based on their understanding of the material. However, simply knowing the material doesn’t guarantee you get the question right. You’ve probably had a time where you knew the information you needed but didn’t answer the question correctly. This results from an error when trying to translate your knowledge in to one of the available answer choices. This ability to apply what you know is part of test-taking strategy.
The simplest way to ensure that you correctly apply the knowledge you have is to do things systematically. Steph Curry and Caitlin Clark shoot the basketball the same way every single time because it reduces errors and optimizes their results. You should try to implement a system consistently when answering USMLE questions so that you can optimize your results and score higher on your USMLE exams. Having a system in place can also help you on specific types of questions that the USMLE frequently utilizes such as arrow questions, acid-base questions, sequential questions and several others. Utilizing a system for USMLE questions helps in a number of ways:
- Keep thoughts organized to work through questions efficiently
- Identify key details and their importance
- Methodically eliminate incorrect answer choices
If you’re interested in the 6-step system I recommend to all my students, feel free to check out my complete guide here.
Why is Test-Taking Strategy Important on USMLE Exams?
So how can studying smarter and testing more strategically help you? In short, studying with proven methods and implementing a systematic approach to questions will allow you to learn more efficiently and achieve your potential on USMLE exams. I work with many students who are trying to raise their scores quickly and they often feel like the harder they study, the less their scores improve, especially as they get closer to their actual exam. This is often the result of working hard with poor study methods or subpar strategies which limits their ability to improve. Most students don’t realize that study skills and test-taking strategies are something that needs to be worked on.
Remember that the art of making an educated guess is overlooked, but if you utilize the right test-taking strategies, you can become that saavy test taker that is envied by all of your classmates. Step 1 has 280 questions on it so let’s pretend that there are 100 that you are unsure on (I think this is a reasonable estimate for most students). If you were able to narrow each of those 100 questions down to 3 choices then you should expect to answer 33 of them correctly. If you had utilized test-taking strategy and narrowed those 100 questions down to 2 choices then you should expect to answer 50 correctly. That’s 17 more questions correct if you could accurately eliminate just one additional answer choice. That’s a big difference that can easily be the difference between passing and failing. For USMLE Step 2, that might be the difference between your goal score and your dream score!
Whether you are trying to simply avoid failing Step 1 (which has become much more common) or score your best on Step 2, focusing on your study skills and test taking strategy may be just what you need!
