Doing Q banks is now considered part and parcel of USMLE review. Any person still not using Q banks is taking a big chance of doing poorly in the examination. In fact I believe one of the biggest reason for the increasingly high scores among both AMGs and IMGs is due to the existence of superb Q Banks, primarily USMLE World and Kaplan. My double 99 in step 1 and Step 2 CK can be attributed to Q Banks. My 90 in Step 3 can also be attributed to Q Banks, rather the lack of a really good one. This is especially true of the Computer Case Simulation portion which is 25% of Step 3 and which I would admit I scored poorly.
So what makes Q Banks so effective for review? At first Q Banks were used to test how well you have learned and your ability to recall the concepts you have learned. However, with the advent of Kaplan Q Bank, followed by USMLE World, Q Banks have now had an expanded role.
First, it simulates the actual examination. This ensures that instead of spending time familiarizing yourself with the software and the intricacies of exam taking during exam time, the exam process itself is now second nature to you and you can concentrate on just the actual examination. An example is learning to drive, if you have to worry about how to operate the brakes, the wheels, the transmission, etc. you are not going to drive very well. But once driving is second nature to you, you can drive effortlessly, concentrating only on getting from point A to point B instead of how to operate a car.
Second, it focuses you on the finer points of tested concepts. In most reviewers, facts are presented as is. However, some facts are slightly more important than others and sometimes reviewers presume you understand the implications of certain facts presented. Q Banks make sure you understand those finer points and sometimes makes explicit what is implied. Especially in step 2 CK and Step 3, the finer points in diagnostic and therapeutic decision making are better illustrated in Q Banks than lectures or notes.
Third, it trains you how to answer tough questions. Even if you can recall what you have read, sometimes you cannot answer the questions based on those concepts. That is the essence of tough questions and Q Banks help familiarize you with tough questions and even teach you how to tackle and answer them. You can read about how tough questions are made here.
Fourth, it covers not just high yield topics but also low yield ones. As explained in my post, High Yield Concepts and the USMLE, one of the important things to do to get a high score is to also review low yield topics not just high yield ones. But going to textbooks can be considered overkill for some even though it usually is the only source of low yield topics. As I said, even among low-yield topics there are higher yield ones and Q Banks are a good source of higher yield low yield topics if you get my drift. 😉
So how do we use Q banks effectively for review? Not all Q Banks are created equal. The most useful for training yourself to do well in the USMLE are still USMLE World and Kaplan. Often, however, a lot of examinees opt to “download” versions of the Q Banks rather than using the online one. And as I stated previously, the biggest benefit in using online Q Banks is that they simulate the exam conditions itself. Aside from copyright concerns, using the “downloaded” version diminishes this benefit. On the other hand, you only need one online version in your review.
The next question is which Q Bank should we subscribe to. The best answer of course, is that if you have both time and financial resources, then use both. USMLE World is best for studying while Kaplan is better for evaluation and test preparation. If you can only use one, then you need to choose the one that suits your needs best. You can read my post on the difference between the 2 Q Banks here. Remember, try to use the online version if you are going to be using one only. That is the way to get the most benefit.
Now, when should I start using Q Banks in my review? In order to maximize the benefits of using Q Banks, you must have reached the following competency in your review process.
First, you have covered most high yield concepts in your review. You can use the Q Banks to master the high yield concepts while appreciating and retaining better the low yield concepts introduced in the Q Banks.
Second, you know enough about the tested concepts that you can appreciate the finer points being focused on by the Q Banks. It is better to say to yourself, “so that’s how to differentiate between the disease A and B” rather than “oh answer is C, let me memorize that.”
Third, when you encounter tough questions, you know it is not because of your lack of knowledge that is making it tough. You can better spot the patterns used to toughen the questions and hopefully learn to spot them and counter them in the actual examination instead of being deceived or distracted by them.
Usually this means that you have finished the major part of your review. However, if you are going to use both Q banks, you can start with one immediately after your first reading or learning phase, preferably USMLE World then reserve Kaplan for final review.
As to Q Banks other than the 2 major ones. Feel free to use them even in your first reading to test whether you can recall what you’ve read. An implication in my analysis above is that there are Q Banks that are good at helping you master and recall specific subjects, while both USMLE World and Kaplan Q Banks are better at helping you perform well in the actual USMLE exam.
We will discuss the NBME assessment exams next time.
For further discussion of this topic: Using Q Banks effectively for USMLE Review II