Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Why students fail USMLE (any of the steps)…

False sense of security

Every year no matter what medical school a student attends, some people are going to fail one or more of the USMLE Steps. (This can apply to COMLEX as well.) I have heard students say that because they attend school X that has a 100% pass rate, they are assured of a pass. Well, that pass rate for School X is characteristic of the class that it applies to. If you are not a member of that class, you have no assurances. Your medical school attended is no assurance of anything other than they have met the standards set by the LCME (Liaison Committee for Medical Education) and that if you have passed your coursework, you will be eligible to sit for your USMLE/COMLEX exams.  With that being said, you have to understand and be proactive if you want to pass and score well on licensure exams regardless of school attended. In short, passage and performance of these very important exams is dependent on how well you prepare for these exams.

The big mistakes

Many students purchase tons of review books and start memorizing questions, outlines and isolated facts as soon as they have been accepted into medical school. You can’t MEMORIZE your way into a pass on licensure exams because these exam require you to master and understand concepts in basic science, clinical science and application of the concepts to patient care. Just memorizing board review books is not sufficient knowledge to do well. Daily and consistent mastery of your coursework with systematic review will enable you to pass and do well on these exams. Many students discount the importance of their coursework with the idea that they will cram in what they need for a course exam and spend the rest of the time memorizing a board review book for the licensure exam. This is the biggest and more common reason that students fail these licensure exams.

Coursework is too detailed for the boards!

While your coursework is very detailed, your mastery of those details (and I mean thorough mastery) is a very significant strategy for doing well on your licensure exams. It’s the details that enrich your understanding of the basic concepts that will be vital to your eventual practice of medicine. Rather than looking for shortcuts or complaining about the rigor of your curriculum, set a strategy for mastery of your materials and get the job done.  As a medical student, I complained about the level of detail in many of my basic science courses but was quite happy when Step I came around and I know those details. The more experience and exposure to the details of concepts, the greater your likelihood of being able to rule out incorrect answers and rule in the correct answer. In short, those coursework details are invaluable both for boards and for “pimp” sessions during clinicals.

Get out of the “I will just memorize this” mentality

You have to learn to evaluate and synthesize concepts in both basic science and in clinical medical science. For the rest of your career, you will largely be teaching yourself the things that you need to keep a mastery of for your practice. In short, keeping up with medical literature means that you master how to read what you need and how to incorporate what you need into your practice. Where do your learn these tasks? You learn these tasks in mastery of your coursework and in preparation for you licensure boards. Just taking a review course and memorizing everything in a review book will set you up for an unpleasant surprise when you open your score report because you must have a solid knowledge base in order to review for a board exam.

Every licensure exam will post a list of key topics to be mastered for the exam. These are never secret and are why books such as First Aid for Step I are so crucial for preparation for USMLE. First Aid contains all of the topics but none of the details. It’s up to you to provide the details and provide the thorough grounding and mastery that you need. This can’t be done in a month-long review course unless you have a solid knowledge base to begin with. The solid mastery that you need can’t be done by memorizing the answers to questions on a website either. While practice questions are good, they are not useful memorization and can give you a false sense of security in the long run. I can’t tell you how many times student Y had told me that they were scoring 70% on Q-Bank but they turn up with a failing score on Step I. Kaplan’s Q-Bank is great but it’s an adjunct to solid study and mastery of basic and clinical science materials (coursework).

Giving Step I more power than it deserves

In today’s world of residency application, residency directors know how much time you as a student have to master the knowledge needed for the USMLE/COMLEX steps. While there will be people who want to take a “year off” to study for Step I in order to insure a high score, this is not a sound practice. Residency directors do not want to see students taking “time off” from medical school unless you are pursuing a higher degree such as MPH or a Ph.D. Utilize the time that you are given wisely and efficiently and you will be able to review completely and comprehensively for this exam within that alloted study time.

Residency directors also realize that IMGs also often have years off to study for the USMLE Steps and take that into consideration when evaluating scores from these individuals. This is why IMGs are usually required to post higher scores on Step I than their AMG counterparts in order to be competitive for a residency program. Another caveat for IMGs is do not attempt any of the USMLE Steps if your language is not up to the standards of that exam. You can’t blame lack of language understanding as a reason for failure of Step I. Residency slots are more competitive (more AMGs now) and failure of any steps can be very problematic for an IMG. In short, if you are an IMG reading this, prepare well and be prepared to pass any of the USMLE Steps with at least a two digit score of 85 (even for medicine programs) on one try. Does this mean your are doomed if you are and IMG and you fail? No, but you have greatly decreased your chances of match in the USA and may have shut yourself out of many residency programs (other than prelim slots) because of the sheer numbers of US grads and the lack of  categorical slots.

Passing USMLE

  • Your first stop is the USMLE website. On that site, you will find the subject lists for what’s covered on the exam and the characteristics of that exam.
  • Your next step is to thoroughly master your coursework with regular and systematic study (if you haven’t done this in the past, start now).
  • Obtain the most recent copy of First Aid for USMLE (whatever step) and read it from cover to cover so that you know what tools are available for the particular exam you are taking.
  • Look into a commercial prep course only if you are certain that your knowledge base is poor or that you know you need plenty of feedback and practice with USMLE-type questions (most US grads don’t need this).
  • Don’t tell yourself that you can’t get into residency if you don’t get a two-digit score of 99. Chances are, you are not going to get that score even if you follow the exact study schedule of someone who did.
  • You have to figure out what works best for you, in terms of mastery and review so that you can prepare your best.
  • If the worst happens and you fail, look at my post “Failing USMLE and how to get beyond it” for strategies for passing on a retry.

Remember, USMLE is not the MCAT. You don’t get “do-overs” for this exam unless you fail. If you fail, you have significantly made yourself less competitive but you are not out of the residency game. You will need to make sure you don’t fail any other steps and you need to accentuate other things (excellent coursework for one thing) in your residency application. Plenty of US grads who have failed Step I but gone on to have a strong third year have managed to match into very strong university-based residency programs. In short pick up and keep moving forward.

Also keep in mind that wishing and hoping for a pass/high score isn’t going to make it so. Plot a strategy and get busy doing what you need to get the job done. Don’t discount the value of consistent strong coursework performance but realize that you have to have mastery of coursework before you can “review” for boards. Board review is not the same as study for your medical school courses. Good luck!

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3 June, 2011 - Posted by | academics, medical boards, study skills, USMLE Step 1

37 Comments »

  1. Hi…am an IMG and preparing for USMLE Step1, did an NBME and scored 202…which was so depressive for me. my exam is in 4 weeks and don’t know what to do. lower performance in pathology , physiology and biochemistry, ordered from worst.any advice please?

    Comment by shargawi | 29 June, 2016 | Reply

    • To shargawi:
      Instead of being depressed (takes up valuable time and doesn’t help you), analyze your performance and make changes from there. Are you just looking at material (cramming) without learning? Are you spending too much time in one spot which makes your brain sluggish? Get up and walk around for 5 minutes out of each hour and come back to studies. Are you distracted? Write down your distractions and think about them when you are taking a movement break so that they don’t interfere with your studies. Try pacing when you study: Pick up the materials and learn them while you walk about the room. Change your study locale (I used to spend a couple of hours studying by a river outside. In short, break up your tasks and cross them off as you do them so that you see that you are making progress. Finally, don’t focus too hard on a particular number but use the results of that number to focus your studies. If you know that your mind like variety, switch from one topic to the next rather than spending hours on one subject. For example, I loved pathology but did 30 minutes of path then 30 minutes of physiology then 5 minute break then 30 minutes of biochemistry etc. Good luck

      Comment by drnjbmd | 30 June, 2016 | Reply

      • Thanks drnjbmd…
        I started to review the Uworld pathology questions with explanations and want to review also Phyio, Pathophyio, and Biochem and then intended to pass over Pathoma too before taking another NBME.
        real talking….are there any chances to achieve 240 in the real deal?
        am ready to to what so ever I can and do what ever plan NO MATTER how difficult it is to touch 40s.
        Thanks in advance…

        Comment by shargawi | 1 July, 2016

      • To shargawi:
        Again, don’t focus on a particular score at this point but focus on making sure you know the material. If your knowledge base is secure, the score will be there. Focus, focus and more focus on knowing the knowledge not memorizing questions. The tendency to memorize specific questions and answers is pervasive for many students but make sure you understand the concepts behind each question rather than rote memorization. Look at your progress rather than focus on a particular score. If you are moving forward, you are on track but your first goal is to pass and the second goal is to pass well. With that in mind, build your knowledge base with your focus on your weakest areas now. Good luck.

        Comment by drnjbmd | 2 July, 2016

  2. hello,

    Im an IMG , completed Md in Radiology, I am looking to do fellowship course in usa hence plan on taking usmle. its been 5 years since i graduated from UG.I have been preparing since past 6 months, have done kaplan once ,u world 1n half times and golijan twice and fa multiple times, yet i am barely passing the nbme , have taken 3 by now and haven posted a score of above 200 equivalent to the usmle score.my expiry period gets over in cpp months , can you please suggest any other methods where i can improve on around 15 to 20 marks as i only need a passing score.
    thanks

    Comment by Dr N Rao | 26 February, 2016 | Reply

    • To DrN Rao:
      I do not have much experience with the nbme. With USMLE, rather than focusing on a particular score on a prep test, focus on where you have deficiencies and get them covered. There are diagnostic tests that will show you deficiencies in specific areas. If you have a knowledge gap, you need to take care of learning that material before you take the USMLE exam. Sometimes students focus on review rather than knowledge acquisition. You can’t review what you don’t have the the first place. Good luck!

      Comment by drnjbmd | 26 February, 2016 | Reply

  3. If you failed the step 1 3 times and got a 250 the 4th time, and step 2ck passed with 1st attempt with 230 , and passed CS on 2nd attempt, 4 yog, and IMG… Do you think I will have a chance of getting atleast preliminary position? Does prelim position count towards residency?

    Comment by bee | 15 October, 2015 | Reply

  4. Hellooooo! As Laura i am an img who has some faling grades during my career, i have a really good fluent english, have a 267 in step 1, 250 in step 2 cs and a 235 in 2ck. I would like to apply to family medicine, what are my chances if u only have one LoR from a US doctor and 1 from a nurse? Is FM easier to get in than psychiatry??

    Comment by Valeria Gomez | 26 July, 2015 | Reply

    • To Valeria Gomez,
      My advice to you as an IMG is that you must apply broadly to programs. With the increased number of graduates of American medical schools, you face increased competition for fewer slots in any specialty. Family medicine has traditionally been noncompetitive but every specialty is competitive for an IMG in today’s climate of a larger pool of applicants + fewer programs. Do you have a chance? Yes, you do but nothing is going to be easy, therefore you maximize your chances of a match by applying to more programs because of increased competition. Good luck.

      Comment by drnjbmd | 26 July, 2015 | Reply

  5. Hi! I am an img with good grades in my step 1, step 2 cs and ck! I have 3 months of observership and 3 LoRs from us faculty, 2 from doctors from my desire specialty and 1 from a nurse. The thing is i had a rough start at med school so i have some failing grades at the beginning of med school, but from there on i have excellent grades on all my classes! What are my chances of getting into a psychiatry residency! Please answe!

    Comment by Laura Tome | 24 July, 2015 | Reply

    • To Laura Tome:
      Your chances depend on where you apply. As an IMG, you need to apply broadly with emphasis on less competitive programs (not high ranked university programs). You are an IMG with not USMLE Step failures but you still face the challenge of competing with a larger pool of American medical graduates. As long as you are prepared for this, you have a good chance of finding a residency program. Good luck.

      Comment by drnjbmd | 24 July, 2015 | Reply

  6. I am an IMG who graduated 5 years ago. I have failed the Step 1 four times and I just took the Step 2 three weeks ago and I failed that as well with a 197. I’m really frustrated with it all. I’ve done Kaplan and Becker courses, all to no avail. I am really thinking of completely giving up on medicine because I have not even the slightest source of income and nothing to show for all my years in med school. Plus, my folks are getting antsy. I spent almost a year reading for Step 2 and got this score. I’m such a diligent student. I don’t know what is wrong. Can I get some advice?

    Comment by Jimmy Dean | 27 May, 2015 | Reply

    • To Jimmy Dean,
      You are taking review courses but you have a severe knowledge gap that no review course is going to fill. You need to spend some time actually learning the material before you can review it. You can’t review what you haven’t learned in the first place. There is no amount of memorizing materials from any review course if you don’t have the knowledge base beforehand. Find a way to get a solid knowledge base before you sit for any more exams. You are also 5 years out from medical school graduation which is going to put you are a significant disadvantage in terms of trying to get into residency in the USA. Most programs have a limit on the number of years post graduation that an applicant can be. You are in a tough situation but before you take any more exams, you need to look at the requirements for application to residency especially the number of years since medical school graduation and the number of retakes on any of the USMLE steps for IMGs. Residency spaces are severely limited for IMGs since there are increasing numbers of American Medical Graduates each year but a static number of residency slots. Make sure you have up to date information and get your knowledge base secure before you take any more USMLE Steps. Good luck.

      Comment by drnjbmd | 28 May, 2015 | Reply

    • What is your update? did you pass?

      Comment by bee | 15 October, 2015 | Reply

  7. I need your advice.
    I am a student that needed a more comprehensive review for this test; my strategy has not been that effective thus far.
    I was always a textbook reader, but I made a plan to use first aid/pathoma twice for this test.
    I don’t think it’s going to get me to where I need to be, I want to delay, but I don’t know by how long. I am supposed to take in about 3 – 4 weeks, and my scores are still below the requirement for passing.

    Comment by john doe | 26 May, 2015 | Reply

    • To John Doe:
      Don’t take any board test that you are not prepared for. The consequences of failing one of these exams are huge. If you are not prepared, figure out your weaknesses and get prepared. You might schedule some time with a professor (or two) in the areas where you are weakest to assist you in your preparation. Take your time, check of things as you get them reviewed and do a comprehensive review (cover all of the things that you reviewed for the previous week) on the weekend. If you are so anxious that you are not preparing effectively, then try to get some assistance with your text anxiety but don’t take and exam when you clearly know that you are unprepared. Good luck.

      Comment by drnjbmd | 26 May, 2015 | Reply

  8. Actually the thing is this I have heard that usml exams in only for MBBS students to register in USA. But latestly I heard that a pharmacist have given usml exams . so I am asking that I a pharmacist give usml exams and passes it will he be only able to practise pharmacy . will he be only registered as pharmacist or will able to practise as physician ?
    Because umsl exams is only for MBBS students . so will he be able to practise pharmacy or will be able to practise as physician as well?

    Comment by Bilal Khan | 30 November, 2014 | Reply

    • To Bilal Khan:
      Pharmacists are not able to take the licensure exams in the United States to practice as a physician. They are not eligible to take USMLE (or COMLEX) unless they have attended medical school in addition to pharmacy school.

      Comment by drnjbmd | 30 November, 2014 | Reply

      • Can you tell me which medical schools I can attend to complete my m.d as I have done pharmacy from Pakistan . I have done extensive search on medical schools in USA . it is of no means . no one is ready to give me admission in m.d as they entertain only national students or there criteria is most toughest … Plz if you can guide me about this . I will be very thank full to you

        Comment by Bilal Khan | 2 December, 2014

      • To Bikram Khan:
        You can research medical schools online as easily as I may research them. Many schools in the US do not accept international students, especially the state-supported schools. You might start with the private schools such as Georgetown or George Washington and go from there. Good luck.

        Comment by drnjbmd | 2 December, 2014

  9. Can pharmacist appear in usmle?

    Comment by Bilal Khan | 11 November, 2014 | Reply

    • To Bilal Khan:
      I am not sure what you are asking me. Pharmacology is well-represented on the USMLE steps thus you need to be well-aware of pharmaceuticals (indications, mechanism of actions) especially those that have significant interactions/cautions (lithium, warfarin etc.). Can you interact with an pharmacist in a USMLE Step 3 scenario? I am not sure if this can happen. I am sure that this is possible but does it happen in any of the scenarios? I can’t answer that question. Can a pharmacist take USMLE? No, one has to be declared eligible for USMLE which a pharmacist would not be able to do without attending an accredited medical school. If this does not answer your question, please restate it.

      Comment by drnjbmd | 11 November, 2014 | Reply

  10. Thank you for this wonderful blog.

    I am an MS2 and in our program we take the USMLE step 1 in April 2014. I have passed all my classes up until this point, but did have a D in Neuroscience and am struggling in Renal. I am getting help, but I am concerned that I have not “mastered” the coursework (particularly the basic sciences). I know you gave similar advice to an IMG above, but I am wondering if you think it wise to start incorporating more thorough course review early, since I know I have weaknesses?

    Thank you for any advice you find the time to give. You’re obviously a dedicated teacher and you are much appreciated.

    Comment by Jo | 25 November, 2013 | Reply

    • To Jo:
      Your “review” is not going to be a review because you can’t “review” what you haven’t learned in the first place. Having a low grade in Neuroscience means that you need to put some emphasis in making sure you have a solid knowledge base in that subject matter. You can’t afford to do much because you likely need a bit more time to master your current coursework (Renal). Set aside a few hours on the weekend to master Neuroscience but don’t take any time away from your current studies. If you were planning to do something fun, take a couple of those fun sessions and utilize the time on Neuroscience. After you are certain that you have mastery of the things that you needed to shore up, move onto a review. When you are done with your coursework, you can then do a review. Neuroscience is not as well represented on Step I as other subjects (Renal Physiology for example) but mastery of Neuroscience is key to understanding many things in medicine especially pharmacology and neurology, critical care and anesthesiology.

      When you are reviewing for boards, don’t feel that you need to be able to recite everything back from rote memory. Do some questions from a question bank and keep a running note of the concepts being tested and how they are tested. This should guide you in your review. Many concepts are mastered when you are able to extend them to unknown problems. What’s the problem and what’s the concept behind the problem? How can you differentiate this concept/disease/pathology from things that are closely related. This is where concept mapping becomes a good tool for review. Try many techniques but don’t try to memorize everything in a review book only to have difficulty linking and relating items. Shoreup your deficiencies but not at the risk of you present work. Make a good schedule and check off things as you cover them. Put most emphasis on pathology, physiology and pharmacology with renal, cardiovascular and respiratory systems being most represented. Remember that even these systems quite interrelated. Good luck.

      Comment by drnjbmd | 28 November, 2013 | Reply

  11. Hey, thanks for the blog. I’m an IMG almost done with second year. In my college, for exams, there would be a set number of important questions/topics to study for. So as a result, we only studied for those important questions. I don’t know any of the other topics in the robbins textbook. Is it important to study all of this material from robbins or can we study them directly from the usmle book? I also feel like the topics I have studied for exams was very rushed and I don’t remember much of them. Should I study all those from robbins too? Or is usmle first aid book enough? I want to take the step 1 in the end of my third year. Would 7 solid months of preparation be enough or should I just study the entire year and take it in the beginning of my final year?

    Comment by Arjun | 5 November, 2013 | Reply

    • To Arjun:
      The first thing that you need to do is go to the USMLE website and download the topics that are tested on Step I (all of the steps for that matter). Armed with that information, you can make a strategy for covering what you need to cover. I can tell you that memorizing a book (review or textbook) is not a sound strategy for doing well on any of the USMLE steps. Those exams ask you to apply your knowledge (not regurgitate memorized items). You need to be able to recognize what the questions are asking you to do and apply your knowledge to the particular problem at hand. These types of questions and application problems required a sound and complete knowledge base. How much time you need or how you acquire that knowledge base is an individual matter. Your schedule of 7 months may be too little or too much time depending on what you need to acquire and refine. The key to keeping your knowledge base intact is regular and consistent study not last-minute rote memorization. The reason that last-minute rote memorization techniques work poorly for application exams is that the information does not stay in your long-term knowledge base. The other thing to keep in mind is that review books are designed for “review” and not for primary learning (textbooks are for primary learning). You can’t “review” what you haven’t learned in the first place. Keep this in mind as you plan your study/review strategy for US licensure exams. Good luck.

      Comment by drnjbmd | 7 November, 2013 | Reply

  12. Hi there,

    I need some feedback about what decision to make, I would like to contact an American Doctor with experience who can provide me with an honest point of view regarding my USMLE pathway situation.

    Firts of all, I am an IMG from Latinamerica, I have two bachelor’s degree (Pharmacy and MD), in addition, I have 2 years work experience as a Clinician and 9 years work experience as a Pharmacist, I have Medical courses such as ATLS, BLS, electrocardiography basic and advance, Airway managament basic and advance, Microsurgery course, Human Anatomic Pieces conservation course, some modest experience research at the undergraduate level, English Academic Studies at the University level from Australia, one semester of a Master Degree in the health field from Australia as well, I decided to come to USA to pursue my dream and goal to achieve my Medical Residency in USA, however, during my Step 1 preparation course my mother was diagnosed with Cancer, as a result, I had to travel back to my home country for Family support, I spent there 6 months figthing against my Mom’s disease and under these circumstances, I continued my Step 1 studies at the same time, I remember studying next to my Mom’s clinical bed for this difficult exam, unfortunately my mom lost her battle against her Cancer and she died, it was so devastating for me, I felt so sad, I mean it was my Mother, I loved her so much, I could not study for the Step 1 exam for 2 months, I mean I abandoned my preparation, but anyways after thinking thoroughly all the effort I had done to take this exam, I decided to take it, I passed with a low score 207 first attempt despite the fact I did not study 2 months before the exam, well , I continued my USMLE pathway, preparing Step 2 CS, practicing with academic partners, writing patient notes and so on, I took my exam in Philadelphia and I got my results last wednesday, I passed CIS and SPE components, but I failed the ICE component as a consequence, I failed the exam, I don’t understand what happened if I considered that I wrote good patient notes and I gathered the Medical and Clinical information properly, now I am so confused and I see my Dream of being a specialist in USA becoming very hard to accomplish, I dod not konw what to do, I know I have the option to retake the Step 2 CS exam, but I do not know if it is worth it, my chosen specialtists were Neurology, Pathology, IM, General Surgery or Neurosurgery. However, I think, I have any chances to match to any of theses specialtists even if I pass Step 2 CS at my second attempt and I pass Step 2 CK and Step 3 with at least 230 score, I really need advices and opinions to make a good decision in orde to avoid regrets in the future.

    Thank you for reading my message

    Jose

    Comment by Jose | 28 April, 2013 | Reply

    • To Jose:
      As an IMG, trying to enter any residency in the United States with any failures on USMLE will be very problematic. The number of slots for IMGs were less compared to the high number of applicants. Since programs have to either offer all PGY-1 slots outside of the Match or none, most programs have elected to participate in the Match. This means that there are fewer positions for IMGs (most US medical schools increased the size of their classes but the number of residency positions didn’t increase) and this means that IMGs can’t rely on the Scramble to pick up open positions (SOAP, not Scramble anymore). If you are aware that you, as an IMG, will have to meet higher standards, in terms of USMLE Step scores with no failures for many residency programs + having some significant experience (observerships and the like) in this country, you can see that it’s going to be a battle for you to enter a residency program in the United States. If you have some connections in a particular program and know that they will be willing to overlook your non-pass, then definitely get all of your USMLE Steps passed with the highest scores possible. Good luck.

      Comment by drnjbmd | 28 April, 2013 | Reply

  13. I m an average student of final year .. I feel like I need to study all d basic science subjects from scratch for usmle step 1.also I m an IMG.. is dere any chance dat i can pass dis exam??

    Comment by ria | 15 April, 2013 | Reply

    • You have to master the subject matter of Step 1. Either you have the material mastered or you do not. Many IMGs master the material thus it can be done. The main question that you have to answer for yourself because you know what you know and do not know is what you need to do to get the job done If you as an IMGS want to enter a residency program here in the US, you need more than just a pass but a very strong score. If you approach Step 1 just looking for a pass, you may achieve the pass but not a strong enough score to enter a residency especially since IMGs are held to a higher standard. You need a “slam-dunk”.

      Comment by drnjbmd | 15 April, 2013 | Reply

  14. Thank you for your advice. You have helped a lot. Good luck with everything.

    Comment by 7billiontravellors | 27 August, 2011 | Reply

  15. Thank you for replying back. You are truly an inspiration! The reason why I was a bit nervous and wanted to go back to some of my previous coursework is because I want to become a physician as passionate as you. You seem to have had a great grasp on your basic sciences and I find this so important in becoming a great doctor. I’m currently going through First Aid and Kaplan which i find very helpful. Do you think clinical rotations would help prepare a student that only just passed during medical school to become a great physician? I really want to master everything so that I can provide the best services to patients in the future and not make silly yet dangerous mistakes.

    Comment by 7billiontravellors | 18 August, 2011 | Reply

    • To 7billiontravellors:
      There is quite a bit of redundancy in the study of medicine. If you didn’t feel that mastered your basic science materials, review them but don’t try to go through every book that you had in an attempt to relean everything as it isn’t necessary and eats up your valuable time. Much of your basic science will be utilized on your clinical rotations as you go through them. If you find that you are forgetting something, a review book is a great recall method. The people who are the most dangerous are the ones who feel that they don’t need to check things once in a while. For the rest of your career, you will be participating in continuing education work which will keep reviewing things that you need to know. Do keep in mind that as you become experienced in a specialty, your knowledge base gets broader in that specialty and tends to narrow in other specialties. This is fine and in no way indicates an inferior physician.

      Comment by drnjbmd | 19 August, 2011 | Reply

  16. First of all, I just wanted to thank you for creating this blog. I have been going over your posts for the past few hours now and have found them very helpful! I have a question I was hoping you can please help me with. Can you please tell me what books you found useful to study from during your course work in school? For example, Robbins for pathology. The reason why I’m asking is this is because i’m currently preparing for my step 1 exam but I feel like I need to rebuild my foundation as I was not the greatest student during medical school. I appreciate any tips on how to do this. I look forward to hearing from you.

    Thanks!!

    Comment by 7billiontravellors | 18 August, 2011 | Reply

    • To 7billiontravellors:
      Going back through textbooks as preparation for USMLE might not be very efficient. Yes, Robbins for path is a good book but it’s far too dense for lisensure board exam review. I spent an entire year with Robbins for my path class thus I hope you get my point. Find some good review books that give a combination of questions and complete explanations of questions. Only use your texts for looking up things that you don’t understand (can do this at the medschool library) but I would not spend loads of time and money on purchasing dense textbooks (great for classroom work) for USMLE study. As I have said in my posts, if you passed your courses-regardless of grades, you already have a foundation for USMLE. You can use good review books (check out First Aid for review book assessments), a through review and you should be fine. This is not the time for overkill or for getting overwhelmed in the revies process but it is the time for making sure that you practice plenty of questions and shore up any gaps in knowledge that might linger.

      Comment by drnjbmd | 18 August, 2011 | Reply

  17. Thank you for this post. I am starting med school at the end of july. When do you think a med student should even start looking at review books.

    Comment by Emelia | 3 June, 2011 | Reply

    • To Emelia:
      You can “look” at a review book any time that you wish but don’t waste valuable coursework study time trying to master something in a review book. You should master your coursework and then use a review book once you have something to review. You can’t review what you haven’t learned in the first place. It’s definitely worth the money to pick up First Aid for Step I a month or so into your first year so that you know what’s out there. FA gives a list of the topics covered on Step I which can aid your organization of your coursework but don’t sacrifice coursework study time because you believe you will be better served by doing board exam study.

      Comment by drnjbmd | 3 June, 2011 | Reply


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