Why You Need Three Phases in USMLE Prep – I

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For most people, preparing for an exam involves learning the material tested in the exam. After doing so, they feel that is enough for them to do well in the examination. For most short quizzes and even shelf exams, that is usually enough. But for examinations like the USMLE, it calls for a different, more thorough approach.

There are people who can study for the USMLE the same way they have always studied and do well. The main reason is that these people already have good study habits and skills which they just carry on into their USMLE prep. They usually do very well in medical school due to these same skills. However, study habits and skills good enough for medical school will be inadequate because of the unique requirements of the USMLE.

The USMLE is different from all other exams for the following reasons

 

  1. It’s coverage is very broad.
  2. It’s a very long exam.
  3. It’s a very clinical exam.
  4. It’s a time-pressured exam.
  5. It’s all or nothing

Let’s go over them in detail

The USMLE has Very Broad Coverage

Unlike most examinations we commonly encounter in medical school including shelf exams, the USMLE covers a lot of materials. For example, when you have a shelf exam for anatomy, you only need to remember anatomy until you finished the exam. Then you can start forgetting it while you prepare for the Physiology shelf exam.

In the USMLE Step 1, you need to know all 7 subjects at the same time and you need to be able to retain and recall all that information on the day of the examination. Therefore, it requires additional preparation in order to do well compared to the usual exams we encountered before.

The USMLE is a Very Long Exam

The USMLE Step 1 is 7 hours long with a 1 hour break totalling 8 hours. The USMLE Step 2 CK is  8 hours long with a 1-hour break totalling 9 hours. USMLE Step 3 covers 2 whole days. The most important problem you need to address here is fatigue. Believe me, by the time you hit the 5th block, your head refuses to work. You need to reread questions. You can’t think straight and it takes longer just to think of the answer.

The USMLE is a Very Clinical Exam

Lately, the USMLE has become more and more clinical, with over 50% of the questions in Clinical Vignette format. This adds a level of complexity to the exam which can impact negatively anyone unprepared for it. Therefore there is a need to make sure you can diagnose clinical cases even in USMLE Step 1 which is primarily Basic Sciences.

The USMLE is a Time Pressured Exam

The questions are long and you need to analyze the questions well before you can answer them. A lot of the questions require two to three step thinking which lengthens the amount of time you need to answer the questions properly. Therefore one of the biggest problems examinees have is finishing the exam within the time period provided. There is a need to take this into account during your USMLE prep and not just during the exam

The USMLE is All or Nothing

For the purpose of the USMLE, if you cannot answer the question, usually in about a minute, then you do not know it. It does not care if you forgot it. It does not care if you can’t just recall it. It does not care if you run out of time. If you can’t answer it, you don’t know it and you don’t get partial points. In medical school, we are used to being graded over our performance for the full semester or year. The USMLE does not care how much time you spent studying, how many sleepless nights you have gone through, nor how may questions you have practiced on. If you can’t answer it, you don’t know it. So again, there is a need to study a certain way to ensure you can answer those questions when the time comes.

We will continue discussion of the three phases of USMLE Prep on future posts.

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16 thoughts on “Why You Need Three Phases in USMLE Prep – I

  • October 18, 2010 at 7:06 am
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    pls doc i have failed step 1 3 times now..i have a big responsibily..i can’t keep failing this exam anymore plus shud i go for step2 & do step 1 later on…pl shelp me

  • October 21, 2010 at 1:00 am
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    Hi tara,

    My suggestion is concentrate on passing Step 1 first before going for step 2 CK. You need to evaluate what you are doing wrong in your Step 1 prep so you can correct them.

    Askdoc

  • December 26, 2010 at 8:49 am
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    hi askdoc am in a big fix.
    i started preparing for usmle 10 months back
    first nbme(6)4 months back 330
    nbme (5) 2.5 months back 440
    UWsa 1 510 2.5 months back
    NBME (4) 2 months back 410
    NBME (7 &2) 2 weeks back 470 in both
    my exam in 4 days. i can’t postpone it cause my eligibility extension expires
    should i reapply.. i would really like a score in the 90 s

  • December 28, 2010 at 4:39 am
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    Dear amair,

    You have a chance of getting low 90’s but not for certain. The next questions is are you plateauing or even going onto decline. If you are, postponing does not make sense as your score will just get lower because your are burning out. You need to assess where you are in your present prep. You will probably score in the high 80’s with a chance to get low 90’s. so it is your choice.

    Askdoc

  • February 3, 2011 at 12:31 pm
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    Hi,
    Am anaesthesiologist,graduated in 1998.i hav taken my step 1 this march.i dont need high scores,i just want to pass.i dont plan for any residency,i just plan to do fellowships.is usmle world enough to pass or ………….plz advice how to go abdt .i hav 2 sons,my hubby is a busy cardiac surgeon doing his fellowship here,so i cant really dedicate tooo many hrs.plz guide me.

  • February 8, 2011 at 6:24 am
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    Hi shree,

    The hardest part about the whole thing is you are are an old grad. Most fresh US grads need to review for about 2 months just to pass this exam. The materials are already fresh in their heads, plus their medical schools prep them to pass this exam. So for an old IMG, its not possible. Even for a fresh grad IMG, its very, very hard. Unless you are a genius. I can’t guide you because I don’t know how to pass it in 2 months as an old grad.

    Askdoc

  • February 8, 2011 at 10:22 am
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    Hi there, I just came across your blog and really enjoy it so far. I have started studying for step 1 and hope to give it in the first week of May. I have tried to learn it by organ or by subject and find it a little hard. I prefer to learn everything related to one disease/medicine in particular. For example, If I am learning about vitamins, I learn the brief understanding of the diseases the deficiency will cause. I find this method a bit more affective since it keeps me engaged, I am ensuring I understand each thing before I move on, and I am integrating it while studying, so when I face usmle world and my exams, I will be well prepared. I just wanted to ask you if you think this is a good idea, or if this will waste time, or take too long. I am hoping to study for just 3 months for this exam , I have no other responsibilities, I am done school and not working.

  • February 19, 2011 at 5:33 am
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    Hi Jenny,

    You are studying it the right way, as integration is very important in the exam. But your study schedule do not have a mastery phase. In learning phase you understand the concepts, in mastery phase, you memorize the concepts in the right amount of detail needed for the exam. You also need to be able to recall them in a timely manner. Remember you have just over a minute for each question. If it takes you too long to recall a detail, then you can’t answer the question. I don’t know if 3 months will be enough though. Maybe to pass but getting a high score is iffy. Unless you are a genius of course.

    Askdoc

  • February 25, 2011 at 8:58 am
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    hey
    I am doing my internship currently and also trying to get a clerkship for a month or so.What i am having trouble with is that I am just not able to strategize my study plan.I am just reading the kaplan notes for now.With very little time available for studies I am not even managing that to my advantage.I will be appearing for the exam after my internship but meanwhile I don’t know how to make the best of the very little I get for some productive studying.Could you please guide me as to what you think would be the best plan for now before entering the full time study schedule?

  • March 11, 2011 at 10:47 am
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    hello,
    I am IMG, graduated in 2003. I took step 1 back in 2005 and failed and never try again until now. I need advise on study, how and from where. thanks

  • March 12, 2011 at 6:06 am
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    Hi ana,

    You can read through the blogs to find tips on how to study, what to study, etc. If you need more handholding than that then you need to get someone to tutor you or enroll in a prep course.

    Askdoc

  • July 30, 2011 at 11:50 am
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    hi there i ave graduated in 2007. and i have been studying for step 1 for 1 year now… not so much hard and fast, say like 6 hrs but i cant do well in nbme …its just 260 although when i was answering everything seemed familiar as i have done usmle consult totally… am i lacking knowledge or i have to memorize the materials by heart… plz give me some of ur precious advice

  • August 22, 2011 at 1:04 am
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    Hi, I am starting my third year medic degree course this coming month. I have heard about usmle from friends and read up about it. I would like to have some advice on this examination. I am worried that my final exams in university will be affected by this usmle exams. I would prefer to have this exam taken during the one-month summer break which will start in end of July 2012.And I think 4th year will start in end of August. I am aware that we are required to choose a 3-month period for the exams. Which 3-months period is the best for me to have the exams? I might be having final exams in uni in mid April with placements up till end of July.

  • September 3, 2011 at 6:12 am
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    Hi shalim,

    Not enough detail. You have touched every subject but have not studied everything in the level of detail needed in the exam. If you listen to my introductory lecture, its not enough to know what to study, but also how much to study and how to study them.

    Askdoc

  • July 4, 2012 at 5:10 pm
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    I am 40 yrs old international grad.I have taken step 1 four times but couldn’t pass for one reason or the other.I think I choke on the day of exam bcause of time pressure or bad racall, I’m not sure.PLEASE…help.

  • July 11, 2012 at 1:00 am
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    Hi Ruby,

    How did you do on the NBME and q banks before you sat for the exam?

    Askdoc

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