The Key to Getting a 99 in the USMLE

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This post has been updated. Please see The Key to Acing the USMLE Step 1.

Since I can remember, everyone wants to know the secret on how to get a 99 in the USMLE. Everyone wants the magic bullet, the one secret weapon that can insure you can get a 99. I had always thought there isn’t one, but after years of reflection, getting my own double 99 and teaching hundreds of people how to pass and score high in this exam, I realize there is a surefire way to get a 99 in the USMLE. The problem is, can you do it?

There are things you need to be able to do and if you are able to do it, then you will be able to get a 99. If you can’t do it then you won’t.

I wonder how many of you have watched the exercise video P90 or Power 90 that promises to give you an incredibly ripped and muscled body in 90 days so long as you follow the video. I thought it was another one of those infomercials that was all hype and no substance. That is until I saw the video. Then I realized that they were right. If you are able to do what they are telling you to do on the video, you will get that body in 90 days. But you know there is always a catch. And the catch is, can you do it? Watching the video, you know most people won’t be able to do it. Either they will find it too hard or some other reason for not being able to do it and thus fail. But if you are able to do what it asks, it’s almost sure that you will get that well-toned body.

The same holds true for the USMLE. If you can do this one thing, then you can get your 99 in the USMLE. But based on my experience, most either can’t or won’t do it. For those who can’t, there is actually little we can do. But for those who won’t, which surprisingly is a large number, I guess it’s just kind of sad.

So What is the key to getting a 99 in the USMLE?

There are actually 3 ways you can get a 99 in the USMLE;

  1. You get a 99 by luck. It also involves some hard work but it’s mostly luck and that is how most people get their 99.
  2. By cheating. Some people get caught, some don’t.
  3. You get a 99 by insuring you do what is needed to get a 99. And you know this is the key to making sure you get a 99. And there are a number of people who got their 99 this way including me.

It is a maxim that the more medical concepts you know the higher your score. However, it is more accurate to say that the more medical concepts you know that come out in your exam, the higher the score you get.

With only 300++ questions appearing in the exam set and literally thousands of medical concepts that can appear in the test, the exam is at most a sampling of what you really know. Therefore as with any sample, sampling error can occur. Since, it’s almost impossible to know everything, the more closely the exam set questions match what you know, the higher your score. The opposite is also true. If the exam set questions are filled with medical concepts you have not studied well, then you can get a lower score. Even if the total number of medical concepts you actually know is equal in both cases.

You Can’t Study Everything

You can’t study everything that may come out in the exam. First, there is really no detailed list of everything that can come out in the exam. Second, most people won’t have the time. Third, even if you have the time, do you have the intelligence and memory capacity to absorb, retain and recall a large amount of information. Lastly, people do burn out from studying too much and too long. And for most IMGs there is still Step 2 CK to worry about.

Getting a 99 by Luck.

For most people who got a 99, they usually start out studying high yield materials. Then supplement it with online q banks that include both high yield and low yield materials. Then if they are lucky what they retain and recall is what mostly comes out in the exam.

Of course to get a 99, they also needed to study hard and have good memory as there is a minimum amount of medical concepts you need to know to get a 99. But luck plays a role because they did not make sure they studied enough that no matter what exam set they got, they will still get a 99. There are many people who studied hard and have good memory who never got a 99.

Getting a 99 by Cheating.

Of course, there is that group of people that cheat by studying actual exam questions they happen to get their hands on. This way, they study not only the exact medical concepts that will come out in the exam, but even the exact questions that will be asked. Suffice to say cheating is not only dishonest and puts your ethical standards to question, your exam results may be nullified and you may be banned from taking the USMLE ever again.

Getting a 99 by Covering All your Bases

Then lastly, there are those who got their 99 by making sure they cover all the bases. That whatever questions do come out, they have studied enough to make sure they will get a 99. Therefore the key to getting a 99 is both simple and hard at the same time. It requires you to overstudy. Not to study everything. As I said it is impossible to study everything but to cover enough of the topics tested that no matter what happens, you get your 99.

There is a catch of course. The catch is, can you study everything needed to ensure that you will get your 99, no matter what? For most people, they actually can’t do it. But for a surprising number of people who didn’t get a 99, actually they could.

First, they need to study harder and cover enough topics in their prep to get a 99. In other words, they need to overstudy.

Second, they need to study correctly to improve retention and recall. Remember you have just over a minute to read through the question, recall what you know, reason out the correct answer, then choose your answer.

Third, they need to anticipate how questions will be asked in the exam and study for it.

Fourth, they need to train themselves to answer USMLE type questions fast and in time.

Fifth, they need to be able to diagnose diseases. Do not underestimate how clinical vignettes can affect your score.

Lastly, they need to do things right the first time, as making mistakes in preparation wastes time. This can lead to burn out, especially if you have to redo your prep to correct errors.

Of course, there is always that genius with a photographic memory that can breeze through everything and get their 99. If you are one of those, ignore everything I have to say about this topic as it does not apply to you.

We will discuss the above in more detail in future posts. Even if you have the various limitations discussed in the post ‘Can You Get a 99 in the USMLE?‘ there are various methods you can use in order to compensate for those weak points and insure you get your 99. But it takes time effort and determination. Can you do it? Will you do it?

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4 thoughts on “The Key to Getting a 99 in the USMLE

  • April 26, 2011 at 8:33 am
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    Hi thank you very much for all the information and advice you have provided on your website, its has been really helpful. I have a question: NBME 11 and 12 have come out and I am confused at to what nbme’s I should take to measure my readiness. You mentioned that taking an easy and a hard one and then averaging the two should be good (like 4 and 7), but I just wanted to know what you thought about the new ones 11 and 12. Thank you.

  • May 9, 2011 at 2:51 am
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    Hi Srikant,

    Sorry, I still have no experience on the latest NBME tests. My recommendation usually comes after I received feedback from my students and other people who communicate with me through my blog. Anyway, judging from past experience, usually the more recent NBME are harder and tend to underestimate actual performance in the exam. So I expect, although I still have to wait for proof, that these new sets will be harder than the earlier ones.

    Askdoc

  • May 15, 2011 at 11:58 am
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    Hey! You cannot even imagine the prayers you are getting for all this. You and the advises you give are simply amazing.
    I’m an IMG currently in my third year of MBBS, I’m planning to give step 1 after about 18 months and before reading your posts i was clueless about where to start from but now i have an idea. My problem is that i have difficulty in corelating, and that is very important since most of the exam is now in an integrated form. So what should i do for that? And lastly how many hours should i study for daily?
    Thanks a million!

  • May 24, 2011 at 7:38 pm
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    I ve never heard of anyone getting 99 by cheating? Are u serious? Everyone gets a different exam, how is that possible?

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