How We learn.

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Note: This article was originally written and posted by me on It talks about how to increase our ability to acquire knowledge. Part 1 is on How we learn and Part 2 is on how to increase our reading speed which is posted here. You can access the original post in prep4usmle here.

We’ve discussed the concept of Mastery Know and Familiar in our Knowledge level and how this will impact our performance in the exam. Continuing our KA discussion, we will discuss 2 topics that is important in increasing our ability to acquire knowledge.

First we will discuss the difference between the way children and young adults learn versus the way adults (those in their late 20’s and beyond) learn. Most people acquire their learning methods while in elem. and high school and continue using the same methods even when they are no longer applicable without some modification.

Second, we will discuss speed reading. Increasing reading speeds 10 to 20 times faster may take years and is impractical for our purposes. However, increasing reading speed by 25, 50 maybe even 100% is achievable within a few weeks and just may be what most of us need to be able to acquire knowledge faster and go through questions faster and fare better in this examination.

When I was in Med School we had a subject called Pedagogy or the science of teaching or learning. It was one of the little 3, Pedagogy, research methods and management which most of my classmates look with disdain and did not take seriously because it is not “Medicine”. You see our school wanted us not just to be doctors but also educators, researchers and administrators. In my case, I was fascinated enough with the topics to go beyond what was taught and do my own research, even after graduation. I came upon a discipline called Andragogy, which is a subdiscipline under pedagogy. Pedagogy, root word “Pedia” concerns itself more with how children and younger people learn, while Andragogy root word “Andro” (for Androgens) meaning Man or Adult, concerns itself with how older people acquire knowledge.

To understand why children and adults learn differently, we have to go back to basic developmental neurophysiology. I have not found any book which effectively discusses this topic, however, what I know of it, I’ve gathered by reading various Journals mostly in Science and Scientific American. Some concepts may even be found in Guyton. I’ll present this in shortened form as a whole treatise may be a book by itself.

How do we learn and how does it get stored in our brains? One theory is that when we learn something new, a neural connection is formed between an axon and dendrite which represents that information. When the learning is repeated, the connection is strengthened and we tend to remember that information longer. Therefore, repeated reinforcement will lead to more permanent learning and that explains why we were taught our ABC’s by repeated reading. However, some believed that continued repetition increases the number of neural connection we create and that is the basis for stronger retention of the information. My own thinking is that it is a little bit of both.

From birth to about 10 years of age, our nervous system is an empty page with tremendous potential for learning. There is very little neural connections between axons and dendrites. As the child grows, neural connections are formed and with repetitive learning, neural connections are strengthened and duplicated. However, after the age of 10 or thereabouts, the neural growth pattern changes. Strong neural connections are strengthened further while weak connections are eliminated ruthlessly. This explains why children have the infinite capacity to learn but lacks mastery and tends to be clumsier, while adults lost this capacity to learn, but what they know, they can master to the fullest. This applies to all types of learning including mental, physical etc.

By the time we hit our 20’s the process of specialization is almost over. Most of us can still learn by just mere repetition, but usually slower and with more effort than those who are younger. This also explains the rather curious finding that Japanese children who never learned to speak another language until after 10 always have extreme difficulty with their l pronouncing them as r. This is because there is no l in Japanese.

Most people still try to learn new things by repetition, but keeps on wondering why they keep on having problems retaining them. This is because adults have lost the capacity to learn by pure repetition. What they already know they can strengthen their retention by repetition. What they do not know, they will have a hard time retaining by pure repetition. This becomes more so as they grow older.

So how do adults learn? By Association. Since Adults cannot form new neural connection, They have to utilize a previous neural connection to build a new one. This is helped a lot by the development of abstract reasoning ability in adults. This abiltiy helps to learn by association. After that, mastering is by just pure repetition

Children can learn unrelated information by pure repetition. When they learn a new information that links 2 previously unrelated information, they can just correlate and continue. This is akin to cementing a driveway. You can cement different parts of a driveway and connect them later.

Adults cannot learn unrelated information. They need to relate that information to something they already know before they can learn it. It is akin to constructing a building. If you have built the first floor, you cannot build the fifth floor until you have built the second, third and fourth floor first.

To Illustrate:

The biochemistry and genetics section in Kaplan Notes is great. Except that when I first read it, it looks greek to me (If you’re greek, it probably looks chinese to you!) Anyway, so I decided to use Lippincott instead. After finishing Lippincott, reading Kaplan was a revelation. There were many concepts you could not master with Lippincott alone, but without Lippincott, I could never learn the concepts in Kaplan Notes let alone master them.

I have a 1996 edition of NMS Genetics, which I read. About 90% didn’t show up in the exam and I knew this. However, I needed about 50% of the material in the book to understand the 10% that is tested in the boards. It also helped me understand the genetics section of Kaplan Notes better.

So what implication does it have on our learning process?

1. If you find yourself having a hard time retaining some information, it maybe because you are trying to memorize information unrelated to what you already know. The solution may be to consult a more basic text so the information could be more readily retained. After that mastery is by simple repetition.

2. At times, you might have to learn board-irrelevant information to understand concepts tested by the board. Do not hesitate to do so if you think that this is the case.

3. When like me, you are faced with a lot of new concepts that you do not know, do not start your study by trying to master or memorize anything. Start reading first to understand the concepts. If you hit the fifth floor in your reading, continue and by the time you finish, you’ve already found your second, third and fourth floor that the fifth floor becomes extremely understandable and masterable already.

4. This is also the reason why it is harder to increase mastery of a concept by doing q’s alone especially if the problem is KA. The information is isolated and may be unrelated to what you already know and therefore retention is harder without associating it with a whole concept.

5. It is easier to learn different interrelated concepts as a group rather than learning this individually. Although sometimes this is not the way it should be recalled. For example, it is easier learning drugs in groups and as I said previously by ‘mastering the prototype, knowing impt. derivatives and being familiar with the more obscure derivatives” But recalling them, esp. in relation to the exam requires you more often to do it on a per drug basis rather than by class, therefore a good recall tool is flashcards. The same can be said of Microbiology. Learn it using books, practice recall using flashcards.

If you discover or know some things based on this learning concept, feel free to give examples and share your experience to help others.

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44 thoughts on “How We learn.

  • July 15, 2008 at 1:30 pm

    I have been studying for step 1 for the past 6 months maybe seriously for 3 months. first time i took nbme i scored 300. i have been doing kaplan q bank, usmle world and i read kaplan material. i have been revising kaplan material along with questions for the past 1 month. what do you think will help me because i still am scoring 350 on nbme?

  • July 15, 2008 at 10:00 pm

    Hi sara,

    Just as important as knowing what to study is how to study. You’ve already told me what you studied and we can safely say that you are studying the right material. The question is how are you studying them? When you stated that you read kaplan notes, did you…
    read it once?
    read it a couple of times?
    took down notes and reviewed them repeatedly?
    mastered the material by doing recall drills either with notes, flashcards of subject specific qBanks?
    It makes a difference, you see on your eventual performance.
    When you did Kaplan and UW q Banks, did you…
    take down notes?
    take note of your thought process when you answered questions to see your weak points?
    or did you just keep on answering q Banks repeatedly again and again? (Doing this does not really help at all unless you do a lot of other things as I’ve outlined on how to use Q banks effectively for review)
    Feel free to describe to me how you actually used those material and maybe we can find out what you may be doing wrong and how that could be improved.

  • July 16, 2008 at 12:51 pm


    Thanks a lot for answering.
    I read Kaplan and reviewed at least 4 times maybe. Im pretty bad with memorizing so i have to do multiple revisions. I did take down notes when i did UWorld and i looked over them once. I didnt take notes when i did kaplan qbank.
    I wrote some things that i always forget on notecards and plan to go over them. I think maybe i’m not really good with some concepts as i think i am.
    Should i read different books cause i only stuck with kaplan. I would like to do well but if i look at other books i’m scared i’ll get confused and when i review i wont know what to review and mess up the exam.

  • July 16, 2008 at 1:01 pm

    Askdoc do you have an email address where i could email you. i know you get a lot of questions about the usmle and all.

  • July 17, 2008 at 1:33 pm

    Hi Sara,
    You can reach me at I prefer though to answer questions through the blog. This is because other readers may have the same problem as you and the answer will help them too. However, I do understand that you may want to keep some things private and if that is the case, feel free to email me.

    Now, I think your problem is both KA and KR just like gigiMD, for whom I wrote my series of posts on what to do in If you haven’t read my advise to her, please read my blog posts on “KA,KR and TP”,” Concept of Mastery, Know and Familiar in USMLE Content” and “Mastery, Know and Familiar applied to USMLE review” in that order. I’ll be publishing part 2 of What to Study for the USMLE later in the day and you should read that as well.

    For the purpose of the USMLE, what you cannot recall in a minute or so, you do not know. It is not enough for you to have read Kaplan, but you should be able to recall what you have read. If you cannot answer a question, it is because:

    1. you do not know the concept because you have not read it
    2. you read the concept but you did not understand it
    3. you read the concept and understood it but cannot recall it in the exam
    4. you read the concept, understood it and can recall it in the exam given enough time, but of course since this is the USMLE, you never have enough time

    In all 4 cases, you don’t get points as far as the USMLE is concerned.

    The best time to know if you got the first 2 right is not when you are doing Q banks or NBME assessment tests, more so during the actual exam. The best time to know if you have the first 2 problems is while reading up on the subject. In fact, it’s best done when you are reading up on individual topics within the subject. For example, Cardiovascular Pathology in Pathology or Renal Physiology in physiology. Doing it later, makes it harder to know which of the 4 problems above underly your problems.

    There are multiple ways to do this. You can
    1. use subject specific q Banks that cover individual topics in the particular subjects, taking them as you finish each section. Robbins and Cotrans Review of Pathology comes into mind
    2 Use flashcards you bought or made yourself from what you have read to test your ability to recall what you have read. Flashcards for microbio and pharma comes to mind
    3. Make outline notes and use them to see if you can recall what you’ve read

    Making notes and your own flashcards require that you be able to judge what concepts are important and what are not instead of using substituted judgment. If you recall what I wrote in What to Study for the USMLE, some people are not very good in judging what concepts to study and are better of trusting other people’s judgment. Also, since if you did not understand a concept, you probably will not put it down properly in your notes, you also will not realize that you did not really understand a concept unless you used q Banks written by experts.

    There is one other problem you may not be aware of and that is the way you store information you’ve studied. When you told me that you are afraid to use materials other than Kaplan because it might confuse you, it indicates that there is a problem in the way you store information in your memory. Normally the more you read, rather than confusing you, the more you should know. It also explains why doing Q Banks and even taking notes do not help you much.

    We’ll continue this later as it’s way past midnight here, actually the sun will be rising in about 2 hours. I’ll continue the post later.

  • July 19, 2008 at 9:27 am

    Hi Sara,

    Let’s continue where we left off. The main reason you have problems with retaining and recalling information is that you do not organize the information you have acquired in your head. That is very important for good retention and recall. If you have not read my post on “Information Recall and the USMLE”, please read them first before continuing.

    For some people, organizing information they have read or heard in their head comes naturally and without effort, just like me. However, for others it is far from natural and they need extra effort in order to do so. Most people can get through medical school with poor memory since the amount of information they need to retain per exam is small. But the boards is different and this weakness can be devastating.

    A good metaphor is if you have around 20 items and you place them in a desk. Since the number of items are small, you can just place them anywhere and you can easily find them. But imagine if you have enough items to fill that desk 3 feet deep. If you just place them on top of each other without organizing them, you know that…

    1. It’ll probably take you a long time to find any item you need, unless you’re lucky enough that it’s on top
    2. That if any item got lost (it fell out of the pile) you may not even realize it
    3. That there is a good chance you will not find the item you need even if its in the pile because its just too disorganize

    That’s the reason you get confused when you read other books, since they just make your pile deeper and more disorganized therefore more confusing. Doing qBanks and taking notes do not help much either because you’ll just pile those information into your head without organizing them into meaningful relationships for easy retrieval.

    These topics actually are for my future posts and will be discussed in more detail there, however, I’ll give you some tips to get you started. In my case, I build an outline of everything I have read to organize them, some in my head, some in a small notebook and some in the sides of pages of the books I have read. Call these outline notes. I have talked to a couple of double 99er’s and they all kept outline notes in varying degrees of completeness. If you read my post on information recall, you know about immediate recall and aided recall. The outline notes, whether written or just in your head is retained in immediate recall and all other information related to the outline is retained as aided recall.

    For example, when studying pathology, you know it’s organized in a certain manner, eg. cell pathology, inflammation, hemodynamic disorders, cardiovascular pathology, etc. Then you know under cell pathology, you have cellular adaptations, apoptosis, necrosis, etc. As you read more information you relate them to information you have under this outline. Keeping the outline in immediate recall is accomplished by repetition, that is rereading the outline over and over. Keeping the detail in aided recall is accomplished by trying to recall the information related to the outline while going through the outline. If you cannot recall them, then reread the actual detail again, until you can recall them automatically as you go through the outline. Most of the double 99ers I talk to did this in their review in one form or another.

    I know its tedious, but I think if you do this for Pathology and maybe even Microbiology/Immuno and Pharmacology, you may get enough information mastered to raise your scores to way above passing.

    I don’t know if you are familiar with the USMLE Wiki project I am currently building. It’s at I have a link here from my blog. Currently, I am still writing pathology and it is just 60% finished. It is based on my own outline notes, however, it has been expanded to include details needed to know enough to score high, therefore it is more detailed than my own actual outline notes. The table of contents and the chapter content outlines represent about 50% of my actual outline notes and you can use that as an initial guide in constructing your own outline notes.

    Try this out first and tell me how you fare. If you need more explanation or detailed help, feel free to contact me. Wishing you luck in your review.

  • July 19, 2008 at 4:33 pm


    Thanks so much for all the help youre giving. What you say makes so much sense and I will seriously follow what you have advised!! I recently took an nbme exam and got 400 so i think i can still improve.

  • July 22, 2008 at 4:10 pm


    Hi..I’m sorry to bother you again with more questions. Im just in a dilemma right now. im scoring 400 on nbme and i dont know if i should go ahead and take the exam in a few weeks or if i should take the kaplan live lectures and take it when i’m more confident and have a higher score. And if i do take the lectures i would like to take step 2 Cs. Do you think its a bad idea to pause step 1 right now? I dont know if kaplan live lectures will help me? I’ve been thinking and cant decide what to do.
    please reply when you do have time.

  • July 23, 2008 at 4:44 am

    Hi Sara,

    First, it is iffy to take the exam at 400. I’ve known a lot of people who’ve asked me for help because they’ve failed, who took the exam at between 390 to 420. In fact, I think they’re luckier than the guys who passed with a 75 and 76, since most of them got 80’s to 90’s after their retake while the guys who passed with a 390 to 420 are stuck with 75 to 76 actual scores. Also as I’ve always said, it takes the same amount of money, time and effort to cancel an exam and take it later as it is to fail an exam and retake it except in the latter case, your chance of matching is less unless you manage a very high score on your retake.

    Second, only way lectures will help is if you learn better using your ears, rather than your eyes and throat (you do subvocalize when you read). I do better reading than listening so I don’t value lectures as much as reading but for some listening is more their thing. Now difference between live lectures and the taped one in Kaplan Review centers is that in the first case, you are under a fixed schedule, which can prompt you to study to keep pace, (or not, as does happen in some cases) and with classmates, you have people who can help spur you on and give you moral support (or as do happen sometimes, drag you down and demoralize you) Anyway, I have helped lots of people who took the Live lecture and still failed but eventually managed to pass with some couching.

    Now, I don’t know if you”ll be interested in this since initially I plan to initiate this in September, but I think I can swing it to start by the middle of August. The past 2 years, I’ve had the opportunity to help dozens of people with their review, most from Prep4USMLE forum. Usually, I set up a study plan for them which they implement over 3 to 6 months. Some went on to review by themselves, others occasionally kept in touch to update me of problems which we then try to solve together. Although, not everyone reported back, those that did reported scores ranging from 82 to 99, In fact 3 got 99’s.

    A lot of them had told me to set up a review class or school to help people and of course to charge for the service as they know that would take up a lot of my time. I am setting up such a class for September. I’ve a curriculum or study plan developed although far from complete with a time frame of 3 to 6 months for Step 1. I plan to offer 6 people and only 6 people to undergo the program for free. I don’t deny that eventually I will charge for the service. However, for these 6 people who will pilot the program, it will be free. But there are requirements that they must meet, including but not limited to

    1. commitment to finish the program in the appointed time,
    2. willing to purchase and/or acquire one way or the other the study materials needed for the review although study material provided by me will be free
    3. will follow instruction and be able to follow prescribed schedule including chat sessions that may be implemented weekly or even more frequently
    4. active participation in discussions of medical concepts and practice questions, etc.
    5. set a goal of 85 or higher and will not register for the actual examination until advised by me of their readiness
    6. will not duplicate and/or sell or distribute study materials developed by me for the sessions

    I will set up a forum, where study materials will be posted for use by participants (in a restricted forum), discussion sessions can be held for materials read and practice questions answered and discussed in group sessions. It will be open to the public for viewing but not for participation and restricted study material wil be off limits.

    I will be announcing this by next week in my blog and in prep4usmle. I prefer to accept people who have failed or as in your case having a hard time raising scores even after much review as I think you people need my help the most.

    As to Step 2 CS, it is basically easy so long as you know what you are doing and your english is proficient. I always advise to take Step 2 CS while reviewing for Step 2 CK as it will help with taking notes and diagnosis. However, if you have lots of clinical experience and good conversational skill, you can take it ahead.

    Think about it and tell me what your decision will be

  • July 25, 2008 at 7:59 am

    Hi Marlene,

    The prep course will not be ready until September, maybe earliest 3rd week of August if I can swing it. I’m just creating the forum where I will be conducting the sessions and it still isn’t ready. I’m still writing out the study materials and it will not be finished by the time this first group starts. 3 to 6 months is a tentative timespan because this is the first time I’m doing this, formally at least, although a couple of people have gone through it informally before.

    The main criteria will be that you’ve failed the exam before, which you qualify. However, if more than 6 applies, then I will require proof of failure before accepting them. After that, it’s first come first serve. And you’re number 2, so long as you qualify, you’ll probably get a slot.

    It also means you have to agree to follow the prescribed schedule and course materials. You can supplement but not subtract from them. If you have any personal or family problem that can cause you to not be able to follow through with the program, then you would be dropped. If you are not able to keep up with the schedule, you will be dropped. You should also have not applied for the next examination schedule yet or are willing to drop it if it conflicts with 3 to 6 month review schedule,ie. September-February.

    There are a lot of other requirements as well which will be published when I make the official announcement in my blog next week. You need to file an application then and so long as you file it by deadline, you retain your number 2 position.

  • July 25, 2008 at 10:16 am

    Dear Askdoc,
    sounds like it is a definite go on my side, yeah! Please let me know where and when I will find the official announcement so I can file an application. I am elated!!!! Please feel free to email me directly. Let me know if you have no access to my email info. Thank you so much for all your great efforts. Please let me know if I can answer any further questions on my eligibility ahead of time. I would be happy to email you to your above mentioned email, with your permission of course. Can’t wait to take this on. Thanks again. Marlene

  • July 25, 2008 at 1:57 pm

    I have had rave reviews of the advice you give.
    Ive also read a few of your posts in prep4usmle and this blog now too.
    I have my exam scheduled on the 31st of july,2008.I did an NBME today,scored 270 🙁 so its needless to say I’m not ready for the exam.
    I have tried to use the Kaplan notes and lectures, too, but find the notes are too precise for my understanding and had to buy the texts to study.I had done the step 2 twice before, and failed it , finally passed on the 3rd attempt.I dont want to go fail this exam too, so Im planning not to turn up for the exam :(.Can you please shed some light, what should i do now to prepare?I seem to have had a burn out too, and dont seem to be able to concentrate anymore.Any suggestion would be a god send. Sincerely,

  • July 26, 2008 at 7:53 am

    First, if you are really burnt out it makes sense to take a break, probably a week or two before starting out again. In order to advise you, I need to know more about your background and what you did in your previous review. What textbooks you used. Are you a native english speaker? Fresh grad, old grad, medical student? etc. Download my “How to create a Study plan for the USMLE” List down your stats so I know where you are coming from.

  • July 26, 2008 at 11:34 am

    Hi Sara,

    You received my email, right?

  • July 27, 2008 at 9:17 am

    I graduated in 2004.English is not an issue.I used Kaplan lecture notes and Kaplan lectures to study from.I find the lecture notes to be too precise , dont make sence to me, Ive always had trouble just memorising random information. I bought Ganongs Review of Medical Physiology and Katzungs Basic and Clinical pharmacology.I used Microbiology Made Rediculously Simple and same for Neuroanatomy too.The first two books (text books) were good, made me understand stuff but I found them too lenghty to revise them and had to use the Kaplan lecture notes for that.Biochemisty I just used the Lecture notes.I listenend to Goljans Lectures in patho and did it form both BRS and Kaplan.I had done the USMLE world que ans and found that i was making lots of mistakes so went back to my books.I ultimately found out i didnt know enuf stuff and my exam date was due :(. I had done my CS exam at the end of April, and cleared that.I had thought Id be able to finish my step one prep by July but I have been falling ill alot this last month.Id been hoping to apply in the match this year but not being prepared yet for this exam seems to have thrown spanners into the works :(.I have downloaded the “Study Plan” too. I dont know if this is information overload but I need help just now.Id really appreciate any suggestion you have.Thank you for your time.

  • July 27, 2008 at 11:14 am

    Hi Shahii,

    When doing your KA (Knowledge Acquisition, in my post KA, KR and TP) there are 2 phases. The learning phase and mastery (or revising or review phase). It is a maxim that you cannot review what you do not know, therefore if there is any concept you do not know you need to learn it first before you can revise it. Reviewers like Kaplan notes, FA, BRS and High-yield are written for revising while textbooks like Katzung’s and Ganong are made for learning. Therefore, you cannot learn using reviewers, you cannot revise using textbooks since they’re too long.

    Textbooks presume that you don’t know anything and will discuss things in detail, that’s why you learn a lot. Reviewers presume you know something already and will not discuss things in details. Information is organized for easier memorization, however, if you have not learned the concepts, things tend not to make sense and harder to memorize.

    In your case, it seems for whatever reason , you have not learned a lot of concepts which you should already know. The reason is usually varied. But this is usually a problem of old grads rather than newer grads like you. But whatever the reason, the first step we need to do is find out if there are still any concepts you do not know.

    Now the ideal thing to do if you have a lot of concepts you do not know, is to go to textbook to learn, then switch to reviewer to revise those concepts. This is what most students normally go through. They study textbooks in class, then switch to reviewers come exam time.

    For older graduates, where lack of knowledge is variable, better method is to use a reviewer, then section by section go through the reviewer,. Each section you did not understand or feel you lack knowledge, go to the appropriate textbook portion to read them and try to learn and understand them. Then revise and memorize the reviewer, not the textbook, but try to recall materials in the textbooks. If you can’t recall them do not be afraid to go to appropriate sections in textbooks to make sure you get it.

    One of your other problems maybe that you do not organize information in your head very well. When you start revising, ie your learning phase is over and you have finished reading through textbooks, you need a way to organize information in your head. There’s just too much information in the USMLE to put them together randomly. If you read some of my comments above, I talked about the need to organize what you learn, then practice recalling them. It’s not enough to learn and revise those information, you need to be able to recall them too and therefore I have always emphasized the need for recall drills in my prep4USMLE post using throwaway q Banks and even flashcards.

    Now, topics on reviewers (two types, outline notes and study notes) plus textbooks is subject to future posts but I will discuss it here briefly.

    Now reviewers are organized more for easier memorization and recall. That’s why they’re usually in the form of bulleted lists or tables. Good reviewers use both but also uses narratives where appropriate. Narratives are important where the concept is actually a process, for example Atherosclerosis, Apoptosis, etc. Sometimes, illustrations are appropriate in some instances too. That’s why its easier to remember what you read in reviewers than textbooks.

    However, generally there are two types of reviewers and you should make use of both. As you yourself said, there are just too much information for you to absorb in the USMLE and that is true for everybody including me. So how to overcome that? First you need to organize the information. This will increase your capacity to remember things. Next you need to put the most important, high yield concepts into Immediate recall and the rest into aided recall. (Read my post on “How we recall information”) Outline notes usually contain only the highest yield material and provide a convenient outline for you to revise them. examples include BRS, High Yield and Ridiculously simple series. First Aid is an outline note, however, its not organized very well, and tends to just toss information together. Now Study Notes contain more details on high yield concepts and low yield concepts, both needed to score higher in the examination. Examples include Kaplan Notes, Levinsion and Jawetz Medical Microbiology and Immunology.

    You use outline notes to organize the information in your head and revise them repeatedly to put them in immediate recall. You use Study notes to cover extra detail and lower yield stuff but put them in aided recall. This is done by trying to recall related information from study notes while revising outline notes. If you cannot recall content of study notes, then go back to study notes to review them until you can remember them by just going through the outline notes.

    In a lot of cases, you do not have good outline notes to pair with a good study notes. What I do in those cases is either write my own outline notes from good study notes, or use outline notes and go to textbook to cover topics not covered in the study notes very well.

    For example, in Physio, I used BRS as outline, NMS as study notes and certain sections of Guyton to cover where NMS is weak. In Patho, I used BRS combined with my own outline notes while going direct to a textbook, Robbins as equivalent study notes. Why? I’m an old grad and since there are just too much information that I have to learn and Pathology being the most important subject in Step 1, I felt that was a good decision and it paid off. Fairly recent grads can use Goljan or even Kaplan’s patho notes as study notes.

    In your case, you have to decided whether you’ve learned the concepts already. If not you have no choice but to go to textbooks. If you have then you can use outline-study note system to revise. I can set up a suggested study plan for you if you want. It tries to follow what I’ve outline above and presume you need a lot of learning to do. We can try it with patho first. You’ll need BRS, Robbin’s Basic Pathology or Pathologic Basis of Disease, and the Q book Robbin’s and Cotran’s Review of Pathology. Alternately, you can use Kaplan or Goljan instead of Robbin’s text, but that presumes you know the concepts already.

  • July 27, 2008 at 12:30 pm

    Thank you for your detailed reply.
    I have BRS and Pathologic Basis of Disease and Q book of Robbins too.
    I have Kaplan and Goljans notes too.I had used Kaplan earlier and then BRS.
    What would you like me to start with first?

  • July 28, 2008 at 8:13 am

    Hi Shahii,

    This study method was done by me in my pathology review. In part, a lot of other people from prep4usmle who emailed me for advise also used this method with varying result. But those who reported back reported scores from 80’s to 90’s eventually. It uses BRS as outline notes and either Goljan or Kaplan Patho as Study notes. Then to Big Robbins for any concept problem. One particular examinee had problems similar to yours, she was having problems understanding concepts while using reviewers, so she opted to use Big Robbins. We then use qBook subject wise to test how well she has absorbed the material. When she was scoring 80 to 85% correct, she revised her goal and was aiming for a USMLE score of high 90’s. Alas, lost touch with her as I was busy with trip to US with Step 2 CS and Step 3 review.

    Anyway, this is how the method goes. First read BRS, first chapter and make sure you semi-memorized the outline even if you have to read it more than once. Answer the questions at the end of the chapter. If you get all correct proceed to Big Robbins (or Kaplan Pathology,etc.) and read up the equivalent chapter. This is important. Try to relate the topics you read in Big Robbins to the outline in BRS, before moving on. If there is anything you did not understand, reread them until you do or you think you do. Now this next phase you can skip if you are doing well, but for the first few chapters try to do it. Reread the chapter in BRS and while looking at the outline try to recall appropriate related items in ‘Big Robbins without reading them yet. If you can’t, reread the appropriate section in Big Robbins. If with just one glance you recall the whole thing then don’t read it in detail anymore. You will sometimes find that just glancing at a few words in Robbins is enough for you to recall everything and you don”t have to read them in detail.

    Once you finish the chapter, proceed to the appropriate section in the Robbins QBook. Answer the items. You don’t have to time yourself strictly, but more or less try to finish it at an average of 1 minute per question. In fact better not to recheck your answers. We’re trying to improve recall and assess your ability to recall fast and not to maximize your points. (Of course the opposite holds true in the actual examination) Check your score without reading the answers, just look at the letters. If you score below your expected percent correct, then do not read the answers at all. Proceed to reread the sections you got wrong in BRS and Robbins. Then redo the qBook until you get the targeted score. In my case, I only reread the book once, despite my targeted score of 90% correct. GI pathology, 88%. So if you want to score well, aim for 75% correct. If you want a high score aim for 85% correct. If you want 99’s aim for 90% correct. Then go to next chapter.

    The reason for doing it this way is because of this.

    If you cannot answer a question it is because;

    1. you do not know the concept because you have not read it
    2. you read the concept but you did not understand it
    3. you read the concept and understood it but cannot recall it in the exam
    4. you read the concept, understood it and can recall it in the exam given enough time, but of course since this is the USMLE, you never have enough time

    Since you are using Big Robbin’s paired to Robbins qBook, you know the problem is not number one so it is either 2 to 4. if you used my method of trying to recall information as you reread the BRS outline, it probably is less due to problem 3 and 4 and more of problem 2. But again since you are using a textbook rather than a reviewer, than there is less chance of it being problem 2. So you see, it is easier to diagnosie your problem. You are left with one answer if you did the review correctly, The question was really tough. You’ll still score about 80% though since only about 20% of Robbin’s q Book question is really tough.

    Once you finish Pathology, multiply the time it took you to finish pathology by 3 and schedule your first eligibility period on that month. For example, it took you one month to finish pathology, schedule your exam eligibility period 3 months after you finish pathology. It will take 2 months to finish the rest of your review and one month for qBanks and appropriate rest before actual exam.

    Pathology is 40% of Step 1, it is only right that 40% of your review time be devoted to it.

  • July 28, 2008 at 10:24 am

    Wow, I just wrote a super long comment for your blog and somehow got kicked out to find your last comment. I just can’t tell you often enough, how “dead on” you touch all the areas that I am still wondering about. Thank you, thank you, thank you…..

    Unfortunately, when I got kicked out I wrote my comment in Word. I had no idea, that I would be unable to copy and paste in this area too. So anyway, I was hoping to have your permission to send my comment directly to your email. Like I said before, I feel wrong to just abuse my knowledge of your email address like this and send it to your without your permission. So please let me know if that is okay.

    For right now let me just ask you this in shorter words.

    I have been reading this blog and Prep4USMLE for several days straight now to determine what to do until I HOPEFULLY can join your study group.

    There is one area that I hardly find addressed though, which I KNOW is a huge and continuing problem for me: Multiple choice and testtaking strategies!!!! It seems, that people who are good at it don’t know why, and I have had too little help with that so far.

    Ever since multiple choice got introduced to my exam schedule in Med School (in the 90’s) and replaced essays, I dropped from a solid top 5% of my class (for 2 years) to just above average for the rest of my Med school.

    In contrast to that, my PhD, which I finished simultaneously, only involved essays, thesis and oral defense. I finished that “magna cum laude” (which is the highest possible honor; and rather unusual in Germany) while at the same time I just finished slightly above average for the Med school part. I probably would have barely been able to finish altogether, if I hadn’t been for “pulling it out of the water” with oral exams which I aced every time.

    History proves that it is still going on…. I find myself second guessing a lot, changing answers, not trusting my first, most often correct, instinct. It seems like it is all “up” there, but I can’t get myself to just doing it. Maybe I am still not comfortable with my knowledge after so many years, and I assume that I have a definite KR problem? I guess, I always feel, I haven’t read enough too. Time is not usually a problem, I trained myself to finish 50’s blocks in less that 35min after the first failure on my step 1. I have to admit though, I couldn’t repeat that during my actual test (only had 4-5 minutes to spare).

    Do you have any suggestions for me in that regard? I would really appreciate your take on that and please let me know about my email. Thank you so much. Marlene

  • July 29, 2008 at 6:17 am

    Hello AskDoc,
    Thank you soooo much for your detailed reply.
    Im going to hit the books now.Id been listening to Goljans lectures on what had been my weakest topics in Patho, but I’ll now start with the way you have suggested.Thanks once more and good luck in everything that do.Off to my books now.

  • July 29, 2008 at 8:42 am

    Hi Marlene,

    I sent you an email to your hotmail mailbox. You can send me a reply through there. If you did not receive the email. Please tell me here.

    Now you’re problem of not being able to decide which is the correct answer, usually down to last 2, I believe tells me that you know the subject matter, but not in the right detail. Since multiple choice questions contain the actual right answer (you don’t have to think about it from thin air), the way to make it tough is to provide distractors in the answer. In other words, answers that are almost right are mixed with answers that are actually right. Therefore unless you know what differentiates two things in detail, you may pick the wrong one. Another method is to provide all answers that are actually true, no answer is false, but only one really answers the question. Again during timed exam, that can distract a person enough to get the wrong answer.

    So what are the causes of not knowing enough detail to discriminate between choices in MCQ.

    First, you did not read it up. You may know details about a concept, but not enough to answer what the question is asking. This is usually the problem of using light reviewers (like FA) only for your review. Oftentimes, so many details are left out that you can’t answer what you do not know. In essays, what you do not know you don’t write about and essays are not graded on how detailed your answers are right, mostly get the gist correct, write well and you get a good grade.

    Second possibility is that you did read about it and probably even memorize it but not in the right context. How you organize information in your head can help you answer questions only if it is stored in the right context. Most often, especially if we use reviewers, we memorize information in bulleted lists and tables without putting them in a different context that discriminates information between them.

    For example. Germ cell tumors are listed down as follows:
    Seminoma – malignant germ cell tumor, most frequent, produces hCG, very radiosensitive, 30 -40’s
    Embryonal carcinoma – malignant germ cell tumor, second most frequent, produces hCG, worse prognosis, 30 to 40s
    Endodermal sinus tumor – malignant germ cell tumor, most frequent childhood, increase in serum alpha fetoprotein, infancy and childhood

    You read and memorize it in that order, which is OK except that when you are required to recall which tumor produces serum alphafetoprotein, you may get confused unless you also memorized it this way. All germ cell tumors produces hCG except endodermal sinus tumor which produces alpha fetoprotein. (This is not entirely true as mixed germ cell tumors can produce either or both.)

    In other words, you don’t just organize them as list of information to be memorized, but also store it in such a way as to allow you to distinguish between them. Making sure that critical differences are memorized in that manner.

    There might still be other possibilities but these are some of the things I could think of. Anyway, these should appear in future posts on how to organize information in your head.

    Hope it helps.

  • July 29, 2008 at 8:49 am

    Hi Shahii,

    A couple more things. BRS do not have chapters on diseases of infancy and childhood and Infectious disease. You should write outline notes from the text. A lot of times, BRS do not contain outlines of information found in Robbins. If you are just after passing, then you can just read parts of Robbins that are found in BRS outline. If a disease entity or concept not in BRS, ignore it in Robbins. But if you want to score higher, you need to expand BRS outline with notes from Robbins. What these notes should contain is a matter of judgment. My outline notes contain, BRS + outline notes I made from Robbins. That is what participants in my prep course will be using instead of BRS. Otherwise, for Patho, this method is basically what participants in the prep course will be doing. They’ll also have additional q’s to answer on top of Robbin’s review of pathology, plus flashcards, or more like flash screens since I plan it to be computer-based.

    Anyway, good luck on your prep and come back with your results.

  • July 29, 2008 at 11:11 am

    Hi askdoc,
    thanks for your input. I think you help me, I hadn’t thought of some of your possibilities yet. You might be right in that organizing the info and memorizing them in a certain fashion is a big problem for me. I am still not quite sure if I understand how to get a handle on that. I suppose adding the missing info in FA would help? I will take some time to analyze it and I look forward to reading about your future comments on how to organize information in my head. That might be just what I am missing. BTW, I got your email, thanks.

  • July 29, 2008 at 6:09 pm

    Thank you for the rest of the information you have provided.
    I know you have talked about starting a prep course in which you would accept 6 students.I was wondering if it would be possible for me to join you too?
    I also wanted to know if I would be able to make the Match this year,2009.I had started the application process,but have not yet sent off the documents.I wanted to do the Step 3 too , to improve my chances for getting into a Residancy program.
    Regardless of your reply,I want to thank you for all your help.
    God bless you for taking out the time to help complete strangers.

  • July 30, 2008 at 12:17 am

    Thanku so mmuch …you are a star esp for me…please i want to be a part of the group as i have failed once…i will do whatever your rules say…but plz plz help me

  • July 30, 2008 at 1:33 am


    thanks alot for your valuable advice…i just love the way you put up things..Please help me as i have failed this exam once and i dont wanna do that again…please can u accept me in the 6 people thing…i promise i will not let you down and i will do all the chat sessions and also if i am given the counselling and a chance i will by the help of god and after him you will get the desired score
    thanks alot

  • July 31, 2008 at 7:51 am

    To Shahii:

    Your chance of getting into the prep course is iffy. As of now, before I have even officially announced the prep course, more than 6 people have tried to reserve a position ahead. So since criteria number one is having failed step 1, you may qualify only if less than 6 people sign up who failed Step 1. Anyway, the process I’m describing to you is almost the same as what will happen in the real prep course. My outline notes is actually BRS+my outline notes-1/3 of BRS that should not be in an outline note. So it will be much more compact.

    Try out the methodology I outlined first to see how it works for you. Then come back here and we’ll discuss how to do the rest. Now, you can still make it to the Match since you’ve finished step 2, however, if you want to do step 3, that will be very iffy indeed. If you do Step 3, you must pass it in one take or you are better off without Step 3. Next, at current schedule, I can’t see you taking Step 3 earlier than January or February next year, even if you do very well in Step 1. By the time results come out 3 weeks later, interview season is over. You may try out and apply now (if cash is not too big a problem) because, then you have a gauge of how many would interview you based on your current credentials. If you don’t like the odds, don’t rank so you can try next year with more complete credentials. It also gives you the opportunity to improve your credentials for next year in case you don’t get interview at all.

    To sara999 and everyone else trying to get a slot in the prep course;

    As I said, more than 6 have already tried to “reserve” a slot via this comment area or via email, so there will be some who wll have to be disappointed. Recently, it seems, due to the upsurge in traffic to my blog and number of people asking for couching or its equivalent, I am having a hard time fixing my schedule. As of now, about a dozen people is on informal couching one way or the other via here and by email. I fear I may have to stop doing that once the online prep course starts.

    I think the only way I could really sustain this is by charging fees, at least for the prep course in the future. So I can afford to hire someone to do the mundane tasks of maintaining the website and help in editing and proofreading. My work on the USMLE wiki has ground almost to a halt in the past 2 weeks and I think the story will be the same once the prep course starts. It took me almost 3 weeks before I could upgrade WordPress (which is dangerous since you can experience security problems if you don’t upgrade ASAP). I have yet to add additional modules to increase the functionality of the MediaWiki, the wiki program I am using for USMLE Wiki. If you noticed, Wikipedia uses the same program but it has tons more functionality than the USMLE Wiki due to the added modules. I can also hire a doctor to cover some of my clinic hours so I have more time to devote here.

    Anyway, the forums is where the prep course discussions will be held primarily. It’s located at The board is still closed since I have whole month of August to set it up. Part of the prep course will be handled at particularly quizzes and flashcards. We will be using Moodle. A course-management program used by educators. It’s still empty too of course

    Again, I still haven’t finished the application form, much less the announcement due to lack of time, but I hope to get that done at most by early next week.

  • August 1, 2008 at 6:54 am

    Hello AskDoc,
    Thank you for all your advice.
    I wish you and the students who join your prep course the best.
    I’ll keep in touch and let you know how my prep goes, and will definatly come back if I come across any more brick walls 🙂

  • August 15, 2008 at 8:35 am

    Hi Askdoc,
    You might not remember me but i had asked for advice back in 2006 .I was actually following a plan for study devised by you which was working very well( i was scoring well in robbins q book ).I have so much respect and appreciation for all the help that you were providing me .Something unexpected happened during the course of my prep and i had to drop the prep to cater to the personal affairs .I could not email and explain it at that time as i thought i had let your efforts go in vain and could not bring myself to face it.
    I can’t believe it’s been 2 yrs .Although my dream has always been to practice medicine ,now i am 7 yrs old graduate (2001 grad) .I am rethinking what should be my priority .Again due to personal financial crunch which was actually created by an unexpected incident in life ,i would need to start working soon .So ,i have been thinking of taking a alternative path.
    Do you have any advice for someone who is an old grad and has to live in US .What is the best alternative for someone who is in need to support family.Since chances of residency are bleak after 7 years ( without any real US LORS plus a big gap in clinical experience and from medical world )I have been thinking about doing MPH or PHD in pathology .
    USMLE steps will still remain a dream .but even after clearing steps ,there is a chance that i might not land a residency .
    Please enlighten me .I think you can provide the most appropriate advice .I look forward to hear from you .

  • August 19, 2008 at 7:50 am

    Mandy, right. I was wandering what happened to you. Anyway, sorry to hear you did not proceed with the exam. Well, being old grad makes it harder to get a position but not impossible. Connections is as important as scores in getting interviews for residency. I met a lot of old grads in my interviews some with average scores, although they got their interview primarily through someone they know in the hospital. One guy who graduated in 1999 got 3 interviews, all through someone he knew in the programs. So doing MPH or a stint in academic medicine can help in providing you with contacts in the future. In between prepare for the USMLE, but only because that is what you really want, to practice Clinical Medicine. Also one word of advise, a friend of mine who is a Pulmonologist in Texas advised me to take Family Medicine instead of IM if I do not plan to subspecialize. He stopped being a Pulmonologist to have more time for family and decided to go into Primary care instead. Its more lucrative to be a Family Med Practitioner if you are into primary care. Since I’m a really old grad, he advised and I agree that a fellowship is not in my future and I am considering going into Family Med instead. A friend of mine who graduated in 1996 and scored in the high 80’s in 2002 got into a Family Medicine Residency in 2008 Match, after 5 years of trying, so I think nothing is impossible.

  • August 21, 2008 at 8:49 am

    Thank you Sir for your advice .I agree that impossible is nothing .I am currently enrolled in MPH program .However that particular univ does not have med school with it .The reason i choose that univ over others was obviously less tuition .
    But now i am considering preparing for GRE and applying for PHD as it also helps you get some grant .
    The principles of learning that you tought me work in every field .I just took a course in health care administration and earned total 98.27%,4.0 GPA from very strict professor who is known to give lowest grades .Actually the enrollment in the courses she teaches is lowest .The q’s that she gives in tests are pretty unfair as well .
    I definitely want to study medicine and practice it .That is my dream .Given a choice ,i would return back to my home country and just do that .How ever i am bonded by circumstances to US .
    You are an inspiration and i am glad that you have blog where everyone can find advice .Thank you !
    I would love the opportunity to join your course and hopefully someday i will !! Meanwhile ,thanks for being here and providing wisdom and precious advice .

  • August 26, 2008 at 9:55 am

    Good for you, Mandy. The first step to a truly great education is learning how to learn. Then no task is too great. No endeavour impossible. Hoping the best for your future and you are welcome anytime.

  • November 7, 2008 at 2:40 pm

    hey askdoc i have been preparing for step1 for almost a year now i m married and besides studies have a husband and a 3yr old son to take care of. initially took triplet for april-may-june extended it for $50 and it got expired then again i have taken it for dec jan feb now.Problem is i havent been to homeland for 5 yrs bcoz of some visa issues now my hubby has bought the tickets which can be returned or extended for 16th of dec, i have taken the exam date of 15th dec (thats the max most i can go). i took NBME yesterday(nov 6th)and got 410(weaker areas Behavio,anat and CNS), do u think i can imrove in 5 weeks plus i cant go without giving the exam coz i will be gone for 3 months so u know if i leave it here i have to redo one more registration fee????
    another thing is i have been neglecting my son and house for pretty long time i m so frustrated that i wanna get rid of this b4 leaving but one has to be realastic. So what do u suggest should i try now or after coming back???

  • November 15, 2008 at 2:19 pm

    hi askdoc,

    i need your help pls………..

    i have been trying to study for step 1 since more than a year now.
    all relatives keep me asking about my exam. i just keep telling them next month , next month ……
    i know i am not prepared yet . i got a lot to study.
    i did most of the study without much seriousness. i have my exam in dec, i just think of postponing and get relaxed. that seriousness what is needed comes temporarily and goes away.
    i read most of the things but i dont remember now.

    what should i do…? i am not planning to quit and i am not putting my 100 % also..
    this step1 preparation time is very depressing and above that i am extending the duration!!

    pls……. somebody guide me , help me.
    i wanna come out of this shameful life.
    help me pls………………….

  • November 18, 2008 at 10:46 am

    hi askdoc,
    iam very interested in all what u do & say here & it help me more than alot , & i want to thank u 4 all this effort just to help someone u even dont know,
    iam an img & i took my step 2 last year outside usa but i didnt prepar well to it & there was alot of things that i didnt know about the nature of the exam, so i failed as it was expected,
    but now i am here with a green card so i decide to take the exame again & belive me work hard this time & i learned alot from the past , but suddenly i read ur text about study plannig & u said (irrepairable hard match when u faild) is that true ,so i have no chance here, so what can i do?
    iam so depressd askdoc , i feel that all what i do is useless, i cant study any more ,
    plz just told me how hard is it & if there is any way to repair it.
    many thanks

  • November 24, 2008 at 4:00 am

    i think you still have the chance. work hard to earn 99’s on step1. and also take step3 with high score. may increase credit for your resume. good luck,friend.

  • November 24, 2008 at 4:49 am

    hi askdoc,
    I read all posts from number 1 down to number 19, very appreciated to what you have done to us, one question: heard a lot of “BRS” and “NMS”, don’t know what that’s stand for?
    thanks very much for your kindness.

  • December 15, 2008 at 7:49 pm

    Dear Askdoc,
    I have this one time opportunity to study for step 1 .My circumstances have changed and seems like i can start prep now and have until august to finish it .i was following a schedule set by you in 2006 .i would like to join the study group .I would really appreciate more information in regards to this .Since my time would be very restrained, i have decided to follow your judgment and expertise .Please let me know how i can join the group .This is my only chance it seems and i would like to aim for 99 .

  • December 19, 2008 at 1:05 pm

    Hi Mandy,

    How are you? I will be starting a second class beginning middle of January to middle of July or six months. You can join that if you like. Wait for the announcement on when enrollment starts. (Prob. next week). Although I will not be charging tuition fees, I will be charging an enrollment fee which is non-refundable. This is to prevent people who sign up to occupy a space and then drop the course without even starting or just attending one day of classes. Therefore, you need to be sure you are committed to finishing the course before enrolling. Slots are limited, and people who enroll then drop after a week or two, are wasting slots.

    About aiming for a 99, I usually ask people not to aim for a 99 but try their best to prep right. If you prep right and it’s meant to be, you’ll get a 99. The problem of aiming for a 99 is that not everybody can get a 99. Obsessing for a 99 can affect your prep and make you perform worst. Once you are in the program, I’ll introduce you to a member of the first batch of attendees who improved her performance a lot after she stopped obsessing about a 99. In fact her chances of getting a 99 is much, much higher than when she was obsessing about it.

    In fact, I didn’t start out thinking I’ll get a 99. I though I’ll be happy with 90 or 95. It was only around a month or so before the exam that I realized I have a chance at 99 and went for it. So most important is to concentrate and prep well and if the chance for a 99 happen to appear, then go for it.

    Mike aka “askdoc”

  • December 19, 2008 at 1:09 pm

    Hi Endura,

    Sorry for the late reply. Was really busy the past month. Anyway BRS and NMS are a series of review books. BRS is Board Review Series and NMS is National Medical Series for Independent Study (NMS-IS). BRS is more concise and better for USMLE review while NMS is more detailed and can be used for both USMLE review and Shelf review.

  • December 26, 2008 at 8:21 pm

    Thanks for your reply ,Askdoc.
    When i begin the course ,i would strive to commit 100%.I hope to be a practicing physician someday.i do believe that with your advice and my commitment ,i might be able to achieve it .
    Happy Holidays and Happy New Year to you!

  • February 5, 2009 at 9:19 pm

    hi askdoc, i hope u still reply to questions. your answers are very helpful. im taking step 1 by may 1 so i need to study in quite a short time. I have asked my friends here what to study. they kept saying to just read the Kaplan lecture notes. Il be doing self review and i thought Kaplan lecture notes is not enough. pls let me know of MUST read books for step 1. thanks

  • February 8, 2009 at 11:33 am

    Hi alysza,

    Sorry for the late reply. The prep course is really keeping me on my toes. I am also currently experiencing an upsurge on my number of patients, so doing a lot of overtime on my day job, too.

    Anyway, have you read my post “Is Kaplan enough for Step 1 Review“? Read it first. What books you need to read depends on a lot of factors. First, what score are you aiming for? Are you a fresh grad, old grad, 3rd year med student? They all make a difference. For most recent grad, who studied more or less properly(esp. if you are AMG), and will be satisfied with passing or getting average scores (80’s) Kaplan notes is more than adequate. Don’t get me wrong, some exceptional people can get a 99 using only Kaplan notes, but I think they are very, very few and rare. I know I can’t.

    So If you want a more definite answer, tell me your present condition and maybe I can give you a more definite answer.

    A bigger problem for me is that you are giving yourself around 3 months to prepare for Step 1. That is advisable only for a recent grad (as in last year) or 3rd year, who is a good student, learns and memorizes very fast and not aiming for a particularly high score. (at most high 80’s, again there are exceptions). You know your capabilities and goals. So only you can determine if 3 months is enough. One more thing, if you are an IMG, you typically need more time to cover topics that are tested in the USMLE but not taught in your country’s med school. That could cover as much as 30% of the materials you need to study. You need to learn these materials, not just review them and that takes longer.


  • February 18, 2010 at 10:35 pm

    Hi Askdoc,
    Thank you for your nice blog I just found.The reason may be my serious problem and I’m searching for help and solution.I’m preparing for USMLE step 2 CK for last 8-9months(but seriously for last 5months).
    I’ve read Kaplan books and doing UW.Read Kap books once and then one more time the HY areas only. Did UW 1st in tutorial mode and read explanation and required areas from Kaplan booksand finished 90% questons.UW avj score was 50%(ranging from 42-60%).
    Then I started doing TIMED MIXED question in TEST mode and avj score is 61%(ranging from 54-74%) and finished 95% questions. After that I took NBME self assessment it’s I decided to take time and do better. Continued UW and Kap books HY and my notes from UW.After 1month took another NBME self assessment->score 370……..I reviewed books HY areas to clear conceptions where I felt weak then took another NBME self assessment->score 340.The problem is that I’m not expecting that much bad after exam and scores r unexpected. I deferred my exam for 3weeks.
    Now doig UW 3rd round with wrong questions and score is around 70-80%.
    Please help me if you could….I’m feeling so low.

    Thank you,


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