What really separates people on the USMLE?

[FollowTheMoney]

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I'm curious as to what really separates people on this exam. What is the main reason some people score in the 250s vs others who are in the 210 or 230 range. Does it come down to memorization? Test taking abilities? Integration/Connections? Repetition/Familiarity? Strong Foundation? Practice Questions? I was trying to formulate a study plan for this exam, but in order to do so I feel like I need to understand what kind of exam I am dealing with and how to best succeed in studying for it. If this thread has been repeated I apologize, I was just looking for some insight regarding a study approach and/or mindset. Thanks.

 

[CDI]

Biggest factor seems to be how someone did in 1st and 2nd year i.e. What is their baseline?

From there (regardless of the baseline score) an improvement of anywhere from 30-40 points is the norm - varies depending on how much prep time you have.

 

[FollowTheMoney]

Biggest factor seems to be how someone did in 1st and 2nd year i.e. What is their baseline?

From there (regardless of the baseline score) an improvement of anywhere from 30-40 points is the norm - varies depending on how much prep time you have.

Well, the reason I ask is because I've seen tons of people who've posted on here who have sworn by a million different methods in order to get that 240+ score. Some have said memorize FA and do UWorld and your set... others say you have to just do a million questions (USMLE Rx, Kaplan Qbank, and UWorld) and supplement with FA because the multiple qbanks will give you a different angle and allow you to have seen almost every type of question they could ask. Some say to do Pathoma, others say Goljan audio + book. Then you have people who say you should preface everything with the Kaplan LN's in order to do well or that FA isn't enough or doesn't provide enough of a foundation. I mean its hard to gauge when you don't know how the questions are asked or what level of knowledge is required (1st order, 2nd, 3rd, etc) and what will suffice.

 

[HoboCommander]

There does seem to be a correlation between test scores in class and test scores on boards, but the test questions are similar, so it is expected.

I think how a select few get 260 from just going through FA+UWorld whereas the other 99% who also go through FA+UWorld have trouble getting 230 comes down to test taking skills. The ones who get 260 have great reasoning and guessing skills. They have excellent reading comprehension and rarely make stupid mistakes.

I know people who have gone through UWorld twice and FA five times, and can't even pass. They get under 180 on NBMEs. They just can't seem to reason their way through questions or read questions the way the test-writers intend.

 

[CDI]

There does seem to be a correlation between test scores in class and test scores on boards, but the test questions are similar, so it is expected.

I think how a select few get 260 from just going through FA+UWorld whereas the other 99% who also go through FA+UWorld have trouble getting 230 comes down to test taking skills. The ones who get 260 have great reasoning and guessing skills. They have excellent reading comprehension and rarely make stupid mistakes.

I know people who have gone through UWorld twice and FA five times, and can't even pass. They get under 180 on NBMEs. They just can't seem to reason their way through questions or read questions the way the test-writers intend.

I've also seen that occur particularly in IMGs.

 

[skyblue2000]

I've also seen that occur particularly in IMGs.

I think it really matters where the person went to school..I definitely don't think all international schools are the same, ex. top 3 caribbean vs. all the rest

 

[CDI]

I think it really matters where the person went to school..I definitely don't think all international schools are the same, ex. top 3 caribbean vs. all the rest

That makes sense.

Caribbean schools have their reputations riding on their students Step 1 performance (so they cater to the exam heavily). Majority of foreign med schools could care less in regards to their students getting by the USMLEs. The latter are the ones whom I've seen struggle, even the well performing students.

 

[HoboCommander]

I've also seen that occur particularly in IMGs.

I'd imagine, since the they are not used to the kinds of test questions on USMLE. But I go to a medical school in California and we have the same problem.

 

[CDI]

I'd imagine, since the they are not used to the kinds of test questions on USMLE. But I go to a medical school in California and we have the same problem.

Why would med students in California have any trouble? I would imagine that number being a real small minority. Having gone through undergrad, med school and being used to multiple choice exams I would think that they should have a leg up.

 

[HoboCommander]

Why would med students in California have any trouble? I would imagine that number being a real small minority. Having gone through undergrad, med school and being used to multiple choice exams I would think that they should have a leg up.

they are students that have always had a hard time taking exams, including the MCAT. they put in the effort, use the same resources, but don't do as well on exams. they are at the other end of the spectrum, those who have bad test taking skills. people say you only need FA+UWorld to do really well on this exam, but it's not true for everybody.

 

[CDI]

they are students that have always had a hard time taking exams, including the MCAT. they put in the effort, use the same resources, but don't do as well on exams. they are at the other end of the spectrum, those who have bad test taking skills. people say you only need FA+UWorld to do really well on this exam, but it's not true for everybody.

Well, UW is ideal for improving test-taking skills, along with NBMEs to simulate. Other than that, there's not a lot these students really have at their disposal.

 

[HoboCommander]

Well, UW is ideal for improving test-taking skills, along with NBMEs to simulate. Other than that, there's not a lot these students really have at their disposal.

Yeah, I think that no matter how much those 180 people study, they will never reach 260.

I think everyone has a limit score depending on their test taking tendencies. After I do an NBME, I usually miss about ~20 questions and go through them. I realize that I can answer every single one correct, but that will obviously never happen, I will get the same incorrect on the next NBME, because most are questions I just tend to miss no matter how much I study.

I can however, read Robbins and do an anatomy review book, and only miss 15 instead of miss 20. But my friend only misses 10, and she had to guess on more questions than me. I simply can't do that she can. She never makes errors, and she knows the psychology of test writers since she was born. Edit: I should mention that in rare cases of errors on NBME, when there are two correct answers according to my research on PubMed, and I picked one of the correct answers and get it wrong. She picks the other correct answer, and gets it right ("this is the one the test writers are looking for!")

 

[CDI]

Yeah, I think that no matter how much those 180 people study, they will never reach 260.

I think everyone has a limit score depending on their test taking tendencies. After I do an NBME, I usually miss about ~20 questions and go through them. I realize that I can answer every single one correct, but that will obviously never happen, I will get the same incorrect on the next NBME, because most are questions I just tend to miss no matter how much I study.

I can however, read Robbins and do an anatomy review book, and only miss 15 instead of miss 20. But my friend only misses 10, and she had to guess on more questions than me. I simply can't do that she can. She never makes errors, and she knows the psychology of test writers since she was born. Edit: I should mention that in rare cases of errors on NBME, when there are two correct answers according to my research on PubMed, and I picked one of the correct answers and get it wrong. She picks the other correct answer, and gets it right.

Yeah, some are great with that. Others can fight their way into that zone by doing a ridiculous number of practice questions.

And then there's me...I fall asleep while doing questions unless under exam pressure. I feel like I'm the only person that can't do a full 46 question block in one sitting without going batsh*t crazy. I still have the same problem when doing CK questions now.

 

[hardee17]

I'm convinced that the difference between a 188-235 is straight up knowledge. 235-250 is integration, 250-265 is critical thinking, 265-275 is test taking ability, 275-285 is largely iq bound, and 285+ is luck.

The higher the score, the more it is dependent on the individual's inherent limits, not lack of knowledge.

 

[JP2740]

I've been hitting 260's on my nbmes and uwsa, but haven't taken the exam. I think I've studied less during dedicated study than most people due to sports playoffs etc, so in my personal opinion I think working my ass off for 2+ years on class notes made the difference so far. I often pull out some little piece of knowledge from a year ago that I can use in answering a question I didn't see in FA. It's helped a lot. Very grateful for the advice that was given to me to just ignore all step 1 stuff until dedicated time.

 

[coolforschool]

I've been hitting 260's on my nbmes and uwsa, but haven't taken the exam. I think I've studied less during dedicated study than most people due to sports playoffs etc, so in my personal opinion I think working my ass off for 2+ years on class notes made the difference so far. I often pull out some little piece of knowledge from a year ago that I can use in answering a question I didn't see in FA. It's helped a lot. Very grateful for the advice that was given to me to just ignore all step 1 stuff until dedicated time.

I think that advice only works if you started studying hard right out of the gate. I barely passed anatomy and crammed for all of biochem, so my foundation was non-existent for those subjects. Luckily, they're not as heavily tested on the real thing, but I'm glad I started studying earlier than my 5 weeks dedicated, otherwise I wouldn't have had time to re-learn biochem and go through anatomy in greater detail which helped on a few questions. I agree though, if you study hard for the first two years, you'll be set to do very well.

 

[JP2740]

I think that advice only works if you started studying hard right out of the gate.

agreed

 

[IJL]

IQ and dedication.

/thread

 

[throwaway1987]

How hard you work the first two years. I don't think there is any magic recipe of review books or way of tackling UWorld that will bring an average student with just enough grasp of the material to get by to a suddenly elite student.

I took my first practice test in early March before I had really started studying and still hadn't covered neuropath in class and scored a 254. My first practice test at the start of my study period was a 264. I pretty much had the foundation down, and I just filled some gaps in. I scored a 275 on the real deal.

 

[HoboCommander]

Those who easily get 260 don't realize their own test-taking gifts. There are those who work just as hard but only get 230. It's like how those of us who can socialize normally, make friends, attract significant others, don't realize how difficult it is for those who don't have the natural talent for that stuff.

Some of us go to DO schools, where they replace 60% of the pathology lectures with OMM, and the other topics are covered in a non-boards oriented way. My school is very clinical oriented and we get a lot of real world experience in our first two years, with excellent physical exam and history taking skills, at the expense of learning the theory. For us, doing well in class is not enough. It's not even enough to pass, forget 260+. We get only three students scoring above 240+ each year, and they basically had to learn everything on their own.

 

[KinasePro]

Biggest factor seems to be how someone did in 1st and 2nd year i.e. What is their baseline?

QFT. In my honest estimation, I had ~20 questions on my exam that could be found in no resource other than my M1/M2 lectures or pubmed. I was fortunate enough to break the 260 mark, and I think it was almost exclusively due to the work I put in during M1&M2. Had I not been aiming for 2 SD above the mean on exams, I would've probably ended up in the 230-240 range despite my luxurious 7 week study session.

Alternatively, there's Pholston's approach which could also push you into the upper echelon of step scores without relying on US med school cirricula. You can tell from his posts that he studies with a near-ideal student mindset, obsessing over mechanisms and deep understanding. I don't have that kind of attention span or will power though, so hard work in M1/M2 was absolutely clutch for me.