You’re likely using USMLE World wrong and it’s costing you a lot of points.

At this point it’s pretty damn unanimous that USMLE World is the best question bank out there and for good reason. It’s got realistic questions; it’s updated constantly, and has detailed answers that cover a large breadth of information. For this reason people often correlate higher World %s with higher USMLE scores and do the question bank multiple times. They have even gone so far as to make a correlation list online about what score you can expect depending on your Uworld %.

While I can see why the logic is so alluring it is that same allure that makes it so dangerous. USMLE World is not simply a fantastic question bank it is also a fairly exhaustive however complex USMLE textbook and if you do not respect both aspects of it you will be leaving precious points on the table. The amount of information it includes is astonishing and often goes far beyond what most people would expect.

To understand how to use USMLE world to maximum effect we must understand the fundamentals of why a textbook and question bank is useful in the first place. Text Books are useful for exams because they give you both the breadth and depth of knowledge to tackle any situation a question writer could throw at you. No matter how much a question is manipulated it cannot deviate from the source material it is based off of. For that reason someone with a full understanding of that material, should be able to think their way out of any question.

USMLE World tends to have the information in a similar amount of breadth and depth needed for USMLE and repeats information in direct correlation with the likelihood of it being seen on exam day (with some exceptions). If a topic comes up six times in a section it is extremely likely to be seen on exam day while ones coming up only once or twice are less likely. However, the downside of it being a question bank rather than a textbook is the information is often segmenting into multiple questions ( work-up in one and treatment in another) preventing you from getting the complete picture needed to answer increasingly complex USMLE questions. For memory and learning reasons I will go into in future articles USMLE World should ALWAYS be done by section ( Cardio, GI, etc). Basically, if you see two questions, each with different parts of the same topic, too far apart you are unlikely to remember to correlate them.

Secondly, You have to read and understand the entire answer as you will find incorrect answers are often summaries of high yield answers to other questions, so while there may only be six questions on pneumonia there may be fifteen with correlated wrong answers that are actually high yield summaries of the information in the six original pneumonia questions which will go even further in reinforcing that high yield topic.

With all of this said it is important to keep in mind that while USMLE World is an exhaustive, and admittedly at times overboard, USMLE textbook it is also complex meaning it has a fairly high level of assumed knowledge. If you go into it with a lack in fundamentals you will find you will miss the nuances needed for higher scores because you are spending significant time piecing together the big picture. USMLE World is not a great resource for this because it’s information is both fragmented through questions and at explained in a way that will be lost on those lacking in fundamentals. You could go through the Qbank multiple times getting the big picture first but this is extremely inefficient and often difficult to do.

USMLE Step 1 is a test with a large volume of information that must be understood and in some cases purely memorized.. You need to be able to both memorize and understand different concepts within the same question, however once you have a grasp on that concept and memorize the facts the questions should not be able to change parameters significantly. This is why a resource that covers a large volume of information ( FA for step 1) and a resource which give you understanding of important concepts (pathoma) is so helpful to build a base here. I should mention for subjects which are very memorization heavy (Pharm, micro, and biochem/genetic diseases) it may be best to use a tool geared specifically towards memorization such as picmonic or anki flash cards, however at the end of the day keep in mind you are only looking to get a base and nothing more. Uworld is where the majority of your learning and understanding will inevitably take place you just don’t want to be lost when you start it.

Step 2CK asks question in an algorithmic way. Unlike many step 1 questions your thinking can not be linear but rather dynamic as answers change depending on the patient presented. After going through nearly every CK resource there are a few which stood above the rest for both simplicity and the way it taught it’s lessons in algorithmically. For surgery and internal medicine do Online Med Ed before you do the corresponding section of USMLE world. Depending on how solid your fundamentals are this may be a quick review or may take more time. When it comes to other sections I have found two books to give the best base when combined. For Ob-Gyn and pediatrics MTB Step 3 and FA for Boards and Wards combined together give a good ( however still not great) base and the rest of the sections can be covered by MTB step 3 on it’s own. Again like Step 1 the majority of your learning will come from Uworld, you just need a base.

Now back to our original position that USMLE World is an excellent Qbank, which it is, but it is important to ask ourselves why having a realistic Qbank is so important. The obvious reason is to maximize our chances of recognizing the way in which examiners like to ask USMLE questions. Okay, but how best do we do that? Many would argue by simulating the test itself, doing it on random and timed then reviewing it later, but they are missing a key point of about learning.

Imagine if you were learning a language and there were two learning options. One would have you go out for eight hours learning the language, record you, then you would come back look at the mistakes with the corrections and try and remember to remember not to make them next time. The other would give you live feedback every time you made a mistake and explain how to do it properly on the spot so when it came up again that day, you would remember not to make it again or get the same feedback until you did. Which one do you think would lead to more efficient learning of that language?

If you complete a large group of questions without knowing if they were right or wrong you are missing out on a key opportunity to get immediate feedback into your thought process when approaching a question. If you go through too many questions at once on timed mode, you miss out on knowing if your thinking was correct both because you do not know immediately if you got the question was right or wrong and because you’ve now gone through so many questions that when you come back to review them you may have forgotten why you picked or did not pick an answer in the first place. For reasons I will get into in more detail in later articles, all questions should be done on tutor mode giving yourself one minute per question then reviewing every 10 – 15 question.

This way you are given immediate feedback on if your thought process was correct or incorrect on a particular question (because you see the answer immediately), you know exactly what you were thinking when you review it ( since you answered it 10- 15 minutes ago), and allows you to learn information then solidify it with later questions because the high yield content repeats so frequently.

For now some of this advice may seem radical but as I delve into the learning process of USMLE you’ll understand fully. For now just trust me this is how you maximize USMLE World. This is how I was able to score 250 and 260 on USMLE while being an avg at best test taker and having very little dedicated study time. This is how you will maximize USMLE World and more importantly your USMLE score.