why is usmle-rx so hard?

[Medical Seed]

Hi, I'm a 2nd year student just started usmle-rx 1 day ago. My school is in renal system right now, and I watched b&b renal section twice, read FA renal 5~6 times, watched sketchy pharm renal 3 times, and watched pathoma renal 3 times. I thought I understood renal pretty well. I can explain everything in FA & pathoma verbally. So I started usmle-rx. I did 17 questions so far and got 24% correct. So my questions are,
1) Is this normal to be really bad at rx though I studied fking hard? I really feel like I'm so dumb.

I think the reason of getting low score is that rx asks me to know 1st year stuff on top of renal. It asks me to know all micros (yeah, it will take super long time to review all the bugs in sketchy), pharm (penicillin, aminoglycosides, antineoplastic drug stuff which I absolutely forgot but they are asking these in renal), basic pharmacology, and immunology. I feel like it is a waste of my time doing more rx right now since I will get wrong whenever I see questions related with 1st year stuff. I was just an average student when I was in 1st year. I just forgot what I learned. I just forgot.
2) so what should I do? My plan was doing 10 questions everyday... but do I have to stop rx for now and review 1st year stuff before resuming rx again?

3) if the reason of getting low score is on me (bc I'm dumb), what should I do ..

I am so serious..

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[Rekt]

Hi, I'm a 2nd year student just started usmle-rx 1 day ago. My school is in renal system right now, and I watched b&b renal section twice, read FA renal 5~6 times, watched sketchy pharm renal 3 times, and watched pathoma renal 3 times. I thought I understood renal pretty well. I can explain everything in FA & pathoma verbally. So I started usmle-rx. I did 17 questions so far and got 24% correct. So my questions are,
1) Is this normal to be really bad at rx though I studied fking hard? I really feel like I'm so dumb.

I think the reason of getting low score is that rx asks me to know 1st year stuff on top of renal. It asks me to know all micros (yeah, it will take super long time to review all the bugs in sketchy), pharm (penicillin, aminoglycosides, antineoplastic drug stuff which I absolutely forgot but they are asking these in renal), basic pharmacology, and immunology. I feel like it is a waste of my time doing more rx right now since I will get wrong whenever I see questions related with 1st year stuff. I was just an average student when I was in 1st year. I just forgot what I learned. I just forgot.
2) so what should I do? My plan was doing 10 questions everyday... but do I have to stop rx for now and review 1st year stuff before resuming rx again?

3) if the reason of getting low score is on me (bc I'm dumb), what should I do ..

I am so serious..

24% doesn't really mean all that much after 17 questions. Although, if you truly did what you say you did then there's a problem. I didn't even get that many passes total of that content combined all the way through second year and dedicated.

Are you actually learning the material? Or are you just "letting it play" or reading too passively? You need to evaluate how you're studying and retaining information.

Unfortunately, boards will be even more integrated than Rx. More akin to UWorld with less buzz words and more vagueness. You should probably focus on understanding your lectures. It's not a popular sentiment on SDN, but it actually provides a foundation (of varying degrees of course) before you start slamming Anki or whatever. If you're just sitting around memorizing first aid without any foundation you're going to hinder yourself greatly. I would still keep doing questions though. Don't do them for the actual question, do them for the explanations.

 

[Medical Seed]

24% doesn't really mean all that much after 17 questions. Although, if you truly did what you say you did then there's a problem. I didn't even get that many passes total of that content combined all the way through second year and dedicated.

Are you actually learning the material? Or are you just "letting it play" or reading too passively? You need to evaluate how you're studying and retaining information.

Unfortunately, boards will be even more integrated than Rx. More akin to UWorld with less buzz words and more vagueness. You should probably focus on understanding your lectures. It's not a popular sentient on SDN, but it actually provides a foundation (of varying degrees of course) before you start slamming Anki or whatever. If you're just sitting around memorizing first aid without any foundation you're going to hinder yourself greatly. I would still keep doing questions though. Don't do them for the actual question, do them for the explanations.

It is so depressing. I didn't skim through them. I read every single word of FA and understood it along with b&b -_- .. I don't know what to do now. I don't think reading renal section more in FA, pathoma, and B&B would be helpful since I can say that every renal thing is in my head now.. I thought the only thing left was doing practice questions..

 

[Medical Seed]

I pressed rx renal section, and did 8 questions today. I got zero. Alright, I reviewed them all. 3 questions were from FA renal section. I didn't know hypovolemia causes prerenal azotemia (though I could explain all other things related with azotemia). I truly learned from it. But other 5 questions were not from FA renal section. 3 were from pharmacology, 1 from immunology, 1 from micro section in FA. Yeah, I read renal section only in FA so far. I haven't read pharm, immuno, and micro in FA yet and that is why I got them wrong. I did 9 questions yesterday and got 55% correct bc most of them were from renal in FA though some of them were from 1st year material. Am I doing something wrong -_- ?

 

[Aerus]

Don't listen to anyone who says this is an issue. What you're going through is normal and it's basically you getting used to not only answering questions in a vignette format, but also getting used to integrating information across all your classes. When I first began Rx, I thought it was incredibly hard and got so many wrong. But after learning the material more and more and practicing UWorld (which is even harder), you can go back to Rx and get 90+% easily. Don't panic. You are doing fine if you are able to verbally explain the information that you are expected to know for the block.

 

[21Rush12]

This bank is for learning, not assessing you. Use it as a tool and don’t be discouraged, you’ve literally been at it for less than a week.

 

[Ho0v-man]

Totally normal experience. My only advice is to start passing through sketchy micro on the side with an Anki Deck if that’s your thing. Uworld infectious diseases is HARD so if you struggle with rx micro you need to step that up.

Keep doing what you’re doing. It sucks, but keep in mind a lot of people crack FA open for the first time in dedicated and feel like you feel now but with way less time to improve. So you’re in a good spot, in a way. You can memorize FA all day, but questions help you integrate and that’s harder.

As an aside: renal was sort of my jam in med school. And I still thought rx renal was a challenge. It also really sucks when you go on sdn/reddit and find everyone crapping on Rx after it just owned you.

TLDR; you’re fine. Make these mistakes now so you don’t make them when it counts.

 

[mistafab]

There is no reason to fret over %correct so long as you actually learn from those mistakes.

My guess is that all your passive learning is making you think you understand the material, so it is good you are being faced with reality on these questions rather than on a real test.

 

[wanderingorion]

Dude I got 10% on some blocks starting out. The information accumulates and you have so much to learn. Don't worry. Learning by questions is a tough on the psyche, but great exposure.

 

[Hippocrates II]

I also just started USMLE-RX and it's humbling me as well. I suspect you're succumbing to the same thing most of us are, which is you hear/read something, it makes perfect sense, and then you don't really integrate it. And I think that's fine, that's what the question banks do, but here's a good example:

I didn't know hypovolemia causes prerenal azotemia (though I could explain all other things related with azotemia).

One of the first things in pathoma is that low blood perfusion to kidneys => prerenal azotemia. Sounds perfectly logical, makes complete sense, and then you move on with the video. Then you get to that question and blank on the answer, which in retrospect is probably obvious to you now, but you hadn't integrated the concept prior to this question. Now you have, you learned from the question, and the question accomplished its purpose.

 

[themoonman2]

You're being way too hard on yourself! Rx questions are very difficult but a great learning tool. Doing 10-20 questions per day is a great idea and was how I approached Rx during preclinical, but I would gradually ramp up more questions as I got closer to exams. As you do more questions, you'll see your averages rise as long as you take the time to review why you got a question wrong AND why you get a question right. Analyze each question in detail- it can take a long time, but is worth it.

The key to everything in medicine is repetition.

 

[AnatomyGrey12]

It is so depressing. I didn't skim through them. I read every single word of FA and understood it along with b&b -_- .. I don't know what to do now. I don't think reading renal section more in FA, pathoma, and B&B would be helpful since I can say that every renal thing is in my head now.. I thought the only thing left was doing practice questions..

Then do questions. LOTS of questions. Do as many as you can get your hands on. Honestly I think doing as many questions as I did played just a big a role in my Step score as Zanki did, if not more honestly.

It's ok to start poorly. If you are trying to use Rx to help you for specific topics (i.e. Renal) then just select for renal path, phys, pathophys, etc. This will cut out some of the random micro and pharm. Rx does sometimes poorly label questions and I remember getting questions on random topics even when I had selected for something super specific.

 

[Hippocrates II]

Then do questions. LOTS of questions. Do as many as you can get your hands on. Honestly I think doing as many questions as I did played just a big a role in my Step score as Zanki did, if not more honestly.

It's ok to start poorly. If you are trying to use Rx to help you for specific topics (i.e. Renal) then just select for renal path, phys, pathophys, etc. This will cut out some of the random micro and pharm. Rx does sometimes poorly label questions and I remember getting questions on random topics even when I had selected for something super specific.

Which qbanks did you use? I'm on a USMLE rx trial right now but I'm not sure if I like the question style or not. Considering switching to amboss or Kaplan but not sure if USMLE rx is better than I'm giving it credit for being.

 

[AnatomyGrey12]

Which qbanks did you use? I'm on a USMLE rx trial right now but I'm not sure if I like the question style or not. Considering switching to amboss or Kaplan but not sure if USMLE rx is better than I'm giving it credit for being.

I did most of Kaplan and Rx along with our systems courses, all of COMQUEST, and all of UWorld. Personally I despised Rx and liked Kaplan more. Kaplan has a heavy emphasis on physiology that actually required a thought process. Rx to me was way too much of "did you memorize and do you remember this one line on page 213 of First Aid." My UWorld percentage was a solid 10% higher than my Rx average lol

 

[Premed2295]

Agree. Everyone says RX is the "easiest" question bank. Its not for me. I do better on UW and on real exams. I dont study to memorize FA I study to understand so the other Q banks work better for me, and IMO map better onto the exams Ive seen. (school exams only, no steps, but we use majority retired NMBE questions.)

I did most of Kaplan and Rx along with our systems courses, all of COMQUEST, and all of UWorld. Personally I despised Rx and liked Kaplan more. Kaplan has a heavy emphasis on physiology that actually required a thought process. Rx to me was way too much of "did you memorize and do you remember this one line on page 213 of First Aid." My UWorld percentage was a solid 10% higher than my Rx average lol

 

[Medical Seed]

thank you for all the comments guys! I was REALLY depressed before due to the poor score. but I really got confidence thanks to all of you, and boosted my motivation to study harder. Thank you so much!

 

[Sukhmani17]

In RX, do most people hit "show explanations"? They briefly explain the wrong answers in the right answer explanation. I want to be able to do at least Kaplan and uworld as well before dedicated, but if I hit " show explanations" its probably a no go for me. Thanks!

 

[AnatomyGrey12]

In RX, do most people hit "show explanations"? They briefly explain the wrong answers in the right answer explanation. I want to be able to do at least Kaplan and uworld as well before dedicated, but if I hit " show explanations" its probably a no go for me. Thanks!

I mean that's kinda the whole point to doing practice questions....

 

[Med Ed]

Hi, I'm a 2nd year student just started usmle-rx 1 day ago. My school is in renal system right now, and I watched b&b renal section twice, read FA renal 5~6 times, watched sketchy pharm renal 3 times, and watched pathoma renal 3 times. I thought I understood renal pretty well. I can explain everything in FA & pathoma verbally. So I started usmle-rx. I did 17 questions so far and got 24% correct. So my questions are,
1) Is this normal to be really bad at rx though I studied fking hard? I really feel like I'm so dumb.

I think the reason of getting low score is that rx asks me to know 1st year stuff on top of renal. It asks me to know all micros (yeah, it will take super long time to review all the bugs in sketchy), pharm (penicillin, aminoglycosides, antineoplastic drug stuff which I absolutely forgot but they are asking these in renal), basic pharmacology, and immunology. I feel like it is a waste of my time doing more rx right now since I will get wrong whenever I see questions related with 1st year stuff. I was just an average student when I was in 1st year. I just forgot what I learned. I just forgot.
2) so what should I do? My plan was doing 10 questions everyday... but do I have to stop rx for now and review 1st year stuff before resuming rx again?

3) if the reason of getting low score is on me (bc I'm dumb), what should I do ..

I am so serious..

USMLE-Rx questions are written by medical students, and when students write questions they tend to focus on esoteric minutiae. Most of the vetting is probably done by residents and fellows. Before dedicated I usually recommend Kaplan or Firecracker.

 

[FalconSlice]

USMLE-Rx is not hard.

I say that part jokingly, but part seriously. I remember when I tried it, I felt like you. "I just read that section of FA, and I STILL got it wrong!" In reality, all of the answers are literally in FA in black and white (thus, "it's not hard...because you've literally read the answers". If I got the question wrong it's because I just read FA and didn't internalize it. Rx taught me more about how precise and anal I had to read, understand and memorize than anything else.

Caveat: this was years ago, so I'm still assuming that Rx gives you a screenshot of FA and tells you the part of the page you needed to know to get the answer correct

 

[libertyyne]

USMLE RX is hard because it is a **** question bank. The questions are written by students and seem like they barely have any quality control. USMLE RX also notoriously will ask you a question around a single sentence or word in FA.

 

[4thtimeretaker]

USMLE RX is hard because it is a **** question bank. The questions are written by students and seem like they barely have any quality control. USMLE RX also notoriously will ask you a question around a single sentence or word in FA.

What do you recommend as a burner QBank to use prior to dedicated to get used to board-style questions. I wanted to save UW for a little later in my second year.

 

[AnatomyGrey12]

What do you recommend as a burner QBank to use prior to dedicated to get used to board-style questions. I wanted to save UW for a little later in my second year.

I preferred Kaplan for this.

 

[4thtimeretaker]

I preferred Kaplan for this.

Okay thank you, I'll look into it. They have 30% off for AMA students, might have to hit up my MD friends for their number. When do you advise switching over to UW?

 

[AnatomyGrey12]

Okay thank you, I'll look into it. They have 30% off for AMA students, might have to hit up my MD friends for their number. When do you advise switching over to UW?

I started in like March I think.

 

[esob]

I use RX as my primary Qbank in M1 and there is almost nothing on the NBME exams we take that isn't in RX.

 

[efle]

Man it still strikes me as ****ing nuts that people in their first semester M1 are doing Qbanks to prepare for the Qbank they'll use to prepare for this ridiculous test.

Anyways, you're scoring poorly on USMLERx because you haven't memorized First Aid yet. Do flashcards, or, if you're stupid like me, wait until dedicated and then frantically try to memorize it in a matter of weeks. Once you've got all their tables and whatnot memorized the questions get very formulaic and easier.

 

[Matthew9Thirtyfive]

Man it still strikes me as ****ing nuts that people in their first semester M1 are doing Qbanks to prepare for the Qbank they'll use to prepare for this ridiculous test.

I’m using qbanks in M1 because my school uses nbme exams, and they prepare me well for being able to answer those types of questions. Since UW is considered the best, I’d prefer to save it for when I’ve done the majority of my primary learning. I think that’s the general consensus. I’m not sure why that’s weird.

 

[efle]

I’m using qbanks in M1 because my school uses nbme exams, and they prepare me well for being able to answer those types of questions. Since UW is considered the best, I’d prefer to save it for when I’ve done the majority of my primary learning. I think that’s the general consensus. I’m not sure why that’s weird.

It's totally sensible in the current clime. What's insane is that none of this even existed half a decade ago. Pathoma, Boards and Beyond, use of competitor Qbanks, anki decks like Zanki and Brosencephalon...none of this existed in early 2010s and here we are talking about how it's normal for newly minted MS1s to be learning medicine this way.

Good for you though man. I had a bunch of friends that did this stuff during MS1-MS2 and they waltzed into dedicated with all of their initial practice tests already in the 240s-250s. If you can stomach the grind, it works!

 

[esob]

I’m using qbanks in M1 because my school uses nbme exams, and they prepare me well for being able to answer those types of questions. Since UW is considered the best, I’d prefer to save it for when I’ve done the majority of my primary learning. I think that’s the general consensus. I’m not sure why that’s weird.

Same here. The RX questions are sometimes almost word-for-word renditions of our NBME questions.

 

[kopftonmd]

To echo some previous sentiments:

Don't worry if you're not scoring particularly well on Rx (or the other big qbanks) if you're preparing for NBME exams. Use them as learning tools mainly, not just as a way to evaluate yourself. I will say, however, that if I was consistently getting >40% correct in 50-question blocks, I knew I was prepared for the NBME (and did above average consistently). YMMV, however.

 

[Deecee2DO]

OP knowing everything in FA BnB and pathoma will only get you so far. You can know everything and not know how to integrate. This is normal when starting with questions. You can read “decreased perfusion to kidneys causes prerenal azotemia” in FA but then in a question on UWorld or Rx they arent going to use the words decreased perfusion. theyll say something in passing that youll have to pick up and know that it causes decreased perfusion like patient was on NSAIDS, patient had been vomiting for days and had dry mucous membranes on physical exam (dehydration). Youd have to know that Dehydration and NSAIDs will decrease perfusion by instinct and pick up on these little physiology and pharm concepts to integrate the information. This is what Rx gets you to do. Youll get better at this as you learn Rx on tutor mode in the beginning and go through UWorld. Youll get there just have to practice. There will be ups and downs too. I was getting 86% on Rx block two weeks ago and this week just got wrecked by GI (hardly got any right). its a rollercoaster man

 

[adrenalinejunkie]

To echo some previous sentiments:

Don't worry if you're not scoring particularly well on Rx (or the other big qbanks) if you're preparing for NBME exams. Use them as learning tools mainly, not just as a way to evaluate yourself. I will say, however, that if I was consistently getting >40% correct in 50-question blocks, I knew I was prepared for the NBME (and did above average consistently). YMMV, however.

@kopftonmd - I started doing USMLE-Rx questions this semester and so far, I have been scoring 38/40% in every block of 50 questions. My USMLE is scheduled for the second week of June and our "dedicated" begins in mid-April. Do you think I'm okay at this point, or should I spend this time reviewing concepts, etc?

 

[efle]

@kopftonmd - I started doing USMLE-Rx questions this semester and so far, I have been scoring 38/40% in every block of 50 questions. My USMLE is scheduled for the second week of June and our "dedicated" begins in mid-April. Do you think I'm okay at this point, or should I spend this time reviewing concepts, etc?

38-40% when you're only a couple of months left in preclinical is rough. I'd start ramping up your studying a lot sooner than mid April

 

[adrenalinejunkie]

38-40% when you're only a couple of months left in preclinical is rough. I'd start ramping up your studying a lot sooner than mid April

@efle what do you recommend doing these next few months other than questions? I'm planning to finish USMLE-Rx by the end of February and start UWorld in March, but do you think I need to do more than just questions/reviewing?

 

[Deecee2DO]

@efle what do you recommend doing these next few months other than questions? I'm planning to finish USMLE-Rx by the end of February and start UWorld in March, but do you think I need to do more than just questions/reviewing?

Questions questions questions and more questions. The more the better and the less you repeat the same questions the better unless youre reviewing incorrects. 40% isnt the end of the world right now youre learning and your test isnt for another 4.5 months. Learn from them dont get hung up on the percent right now. If your test is in June you should be on tutor mode right now learning how to integrate concepts and getting down a good foundation

edit: ramp up the studying though if you can like elfie said. but like i said dont get hung up on percent right now

 

[efle]

Yeah in hindsight when I started ramping up I did it by watching a bunch of pathoma and boards and beyond. Better approach would be to just burn through as much Kaplan and Qmax as you can by the time you start Uworld

 

[kopftonmd]

@kopftonmd - I started doing USMLE-Rx questions this semester and so far, I have been scoring 38/40% in every block of 50 questions. My USMLE is scheduled for the second week of June and our "dedicated" begins in mid-April. Do you think I'm okay at this point, or should I spend this time reviewing concepts, etc?

Like others have said, ramping up your studying for the Step exams and doing lots of questions is paramount. My comment was more intended for the customized NBME unit exams that many students come across in preclinicals, not the Step exams. Best of luck!