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How to Review UWorld or Other QBank Questions

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by Alec Palmerton, MD in Plan

We’ve all heard it or thought it. “I just need to do more UWorld questions.” While there are plenty of reasons to be using a QBank, the advice “just do more QBank questions” is simple, albeit incomplete. Specifically, what exactly does “doing UWorld” mean? How are you supposed to read the question, exactly? And once you’re done, how do you review it?

Do you get to the end of a UWorld question and wonder how to remember all the information? Are you tempted to make Anki cards on everything you don’t know? Have you been doing UWorld questions and not seeing your scores improve as much as you want? It may not be a problem with doing enough questions. Instead, it may have to do with how you’re reviewing them.

In this article, you will learn:

  • How to review questions so you can know the right answer automatically,
  • The reasons why people miss questions and how to address each,
  • Simple ways to get more questions right without learning more,
  • The right ways to make Anki cards on UWorld questions, and
  • Much more

Table of Contents

Question Interpretation: How to Read a Question to Get More Points Reliably

How often have you studied something only to get it wrong on your test? Even worse, how many questions have you missed because you didn’t even realize what the question was asking?

There are many reasons to miss questions on a topic you’ve studied. A large portion of these mistakes deals with how you interpreted the question.

The basic steps of question interpretation are:

  • First, recognize that every sentence has a purpose. Gone are the days of buzz-words being the key to Step 1. Why has the test had fewer and fewer questions over the years? Because each item is more extended and takes more time.
  • Second, ask what every sentence means in context. Every sentence has a meaning. However, if you only consider that sentence by itself, you’ll jumble your thoughts.
  • Finally, understand what they are asking you. The USMLEs often have convoluted questions. Know how to simplify what they are asking. In the Yousmle Online Course, we call this the “stand-alone question” (SAQ). You should re-phrase the question to “stand alone” without using the vignette.

For more on the question interpretation process, read this article.

Look at WHY You Missed the Question

What about the questions you’ve interpreted but just plain didn’t know? The topics where you don’t even know where to start. What do you do to review your missed UWorld questions?

There are lots of reasons you can get a question wrong. Conversely, there is only one way to get the answer for the right reasons. To get questions right reliably, you need:

  • Mastery, retention, and application of the concept(s) tested (e.g., I have mastered the various aspects of microcytic anemias) and
  • Proper recognition of those concepts (e.g., I can recognize α- and β-thalassemia based on the vignette)

Want to review UWorld questions to improve your USMLE scores? Your first step is to figure out WHY you are missing questions. The reasons people miss questions fall into one of three categories:

  • Lack of concept mastery – having memorized rather than understood a particular concept or condition
    1. Ex: missing a question on sepsis because you lack an intuitive understanding of preload, afterload, and contractility
  • Lack of recognition – not preparing correctly, so you don’t know the significance of critical signs/symptoms
    1. Ex: failing to recognize an aortic aneurysm signs/symptoms due to not having previously made sense of how it could compress the recurrent laryngeal nerve (causing hoarseness/voice changes) and/or airway structures (causing cough, dyspnea, etc.)
  • Unforced errors – reading too quickly and/or carelessly, so you fail to recognize a particular clue
    1. Ex: reading too quickly and not seeing that question asks, “which of the following would INCREASE due to the patient’s condition?”

Address Each Reason for Missing the Question Differently

“Failing to prepare is preparing to fail.” – Benjamin Franklin

And as we learn from probability theory, the expected value of a question is:

(Probability of getting the question correct) x (# points per question)

Since the points per question are fixed, we maximize our score by maximizing the probability of getting each question correct.

Once you’ve identified WHY you got the question correct, you need to address it, so you maximize your chances of getting any related question right in the future.

How to Improve Concept Mastery During UWorld Review

One of the most important aspects of reviewing UWorld will be how to address gaps in your foundation. Most people will feel tempted to rush so they can “cover” more material. When faced with a seemingly unchangeable deadline, most of us try and “see everything” in the shortest period.

Unfortunately, the tendency to rush has predictable costs. The biggest downside to rushing is that it is usually slower. Not spending enough time to learn something well ensures we will need to re-learn it again in the future. And when that time comes, we’ll have even less time, feel even more stressed, and be even less likely to spend the time necessary to learn it well.

Instead, when improving concept mastery, remember, “slow is fast.”

Next, take the time to move beyond memorization to understand “why?”

And if you do feel pressed for time, you can accelerate your studying while learning even more deeply by using the Yousmle Online Course. We take the time to master, integrate, and simplify the most important USMLE concepts so you can learn more in less time. For a free consultation, sign up here.

UWorld Review: Improving Recognition for Next Time

Another critical aspect of reviewing a UWorld question is to make sure you improve your recognition. Recognition encompasses:

  • Knowing the correct diagnosis and/or
  • Understanding how a particular sentence fits into the bigger picture

Take the following simplified vignette:

A 56-year-old man is brought to the emergency department with 3 hours of chest pain radiating to his left shoulder. He reports shoveling his driveway when he felt sudden chest pain and lightheadedness. The patient decided to rest, but he came to the emergency department when the pain didn’t subside. He has a history of uncontrolled hypertension. He occasionally drinks on the weekend and smokes one pack of cigarettes daily. Vitals are HR 42/min, BP 90/50, RR 18/min, and O2 sat 98%. On exam, he is diaphoretic. He has jugular venous distension. Cardiac auscultation demonstrates no murmurs. His lungs are clear to auscultation. His EKG demonstrates sinus rhythm, with 1.5 mm ST-elevations in leads II, III, and aVF.

What is the most likely cause of this patient’s bradycardia?

    • A. Brugada syndrome
    • B. Ischemia to nodal tissue
    • C. Congenital heart disease
    • D. Inflammatory disease
    • E. Ventricular arrhythmia
    • F. Sick sinus syndrome
    • G. Electrolyte imbalance
How to Get Questions Right Automatically the Next Time

This vignette has many aspects, making it a challenging Step 1 question or a typical Step 2 CK/Shelf question.

Let’s start with the obvious. He has an MI, an inferior STEMI, to be exact, given the ST-elevations in the inferior leads II, III, and aVF.

If you missed the inferior MI, that would be a recognition problem. Simple enough!

However, what about all of the OTHER sentences. Did you understand the significance of his smoking history? The fact that it was 3 hours of chest pain? That he was lightheaded? Could you relate any of these things with his vitals – particularly his bradycardia and hypotension?

That would be a recognition problem if you didn’t connect these things.

If you’re curious: smoking is a significant risk factor for coronary artery disease, the precursor to a plaque-rupture MI. The fact that his chest pain was 3+ hours tells you this is supply ischemia (plaque rupture event) rather than demand ischemia (stable angina). He’s bradycardic because he has an RCA occlusion (and presumably has a right-dominant circulation), which feeds the SA node; SA nodal ischemia can lead to bradycardia. Finally, his bradycardia has led to his hypotension, which has led to his lightheadedness, since with hypotension comes a decrease in cerebral perfusion pressure and thus cerebral perfusion.

The more you understand about every sentence, the more likely you will get each question correct.

What If We Can Still Get a Question Right, Even If We Don’t Understand Every Sentence?

You may be wondering, “why would I need to understand every sentence? I could get to the right answer with only understanding 50% of the vignette! Why try and understand more?”

Indeed, you don’t need to understand every sentence to get a question correct. However, you can prove easily that aiming for the minimum necessary information to get a question right is a flawed approach.

Let’s take basketball as an example. Do I NEED a good shooting form to make a basket? Of course not. If I closed my eyes and shot the ball 50 feet away, the ball would go in the hoop some (tiny) fraction of the time. The “minimum” effort, as it were, is simply that I throw the ball in the general direction of the basket.

However, I would make very FEW baskets this way. It doesn’t take a lot of imagination to understand that with every improvement – better form, opening my eyes, moving closer to the basket, etc. – I improve my chances of making a basket.

The same is valid with question interpretation. I may not need to understand anything about the vignette to get it right. Conversely, knowing how everything fits together doesn’t guarantee I will get it correct. However, the more I understand why the question writer chose every sentence, the better my chances. And every time I improve my chances on a question, I add points to my score. As discussed above, our expected score is simply the sum of individual probabilities of all the questions on our test.

How to Improve Recognition with Anki: Pathophysiologic Chronology Cards

So, the more we understand why the question writer chose every sentence, the better our chances of getting that question. And in total, the better our chances of getting each question correct, the higher our overall score.

So how do we understand what every sentence means? By taking the time to make a pathophysiologic chronology (PC) Anki card. A PC card helps us explain EVERY sentence in the vignette, starting from the day the patient was born. An example would be:

Summary:

RCA plaque rupture → inferior STEMI + SA node ischemia → bradycardia → cerebral hypoperfusion

Detailed:

Patient born healthy with right-heart dominant coronary circulation. Poor lifestyle factors/hypertension → unstable atheromatous plaques in coronaries → rupture of RCA plaque during exertion → RCA STEMI → SA node dysfunction → bradycardia → CO ↓ → MAP ↓ → cerebral perfusion ↓ → lightheadedness.

Note that I’ve written a concept-focused summary of the more detailed PC. The summary allows me to:

  • Consolidate/reinforce my conceptual mastery, and
  • Facilitate future reviews by making them faster/smoother

Making and reviewing PC cards help make recognition more automatic. You’ve probably already experienced this on questions you are familiar with. You read the first sentence or two and get an immediate intuition.

PC cards force you to make sense of every sentence in questions you’re unfamiliar with. Since many of these sentences will repeat/be similar on your exam, these reviews will help you improve your speed and accuracy on your exam.

UWorld Review: How to Reduce Unforced Errors

The final way to review UWorld to maximize each question’s odds is to look for unforced errors. Unforced errors occur when we are inattentive and/or read too quickly.

You can find these errors by re-reading questions and finding things you missed. For example, let’s say that in the STEMI question above, you misread the EKG. Instead of seeing ST-elevations, you thought the EKG was normal. Even if you understood the concepts well – and COULD have interpreted every sentence – because you misread the vignette, you still got the question wrong.

There are many ways to cut down on unforced errors. The three simplest ways are:

  • Read more slowly, and
  • Address anxiety
  • Assess (and work on) burnout

Reading more slowly should be self-explanatory. We read quickly, thinking we’ll move faster through the question. However, reading fast is often SLOWER, since the faster we read, the more likely we’ll miss important information and need to re-read the vignette.

Anxiety and burnout both affect our attention and comprehension. Read more about flow – a concept that can help with burnout – read this article. To read more about how to address test-taking anxiety, read this article.

A Quick Note on Timed vs. Untimed UWorld Blocks

A quick note on whether to use timed vs. untimed/tutor mode on UWorld or other QBanks. There is a certain tension here. For virtually all forms of learning, immediate corrective feedback is best. Thus, doing tutor mode can help with building your foundation. However, your exam will be timed, so practicing timing is essential.

Whether you use timed vs. untimed/tutor mode for your UWorld review will come down to your goals and when you’ll take your test. If you need to improve your foundation, using untimed/tutor can be best, especially if you have at least 1-2 months until your exam. As you get closer to your test, though, it is best to mix in some timed questions.

Concluding Thoughts

The advice that we’ve all heard and followed is “just do more UWorld questions!” While QBank questions are necessary for improving your USMLE scores, simply doing more UWorld questions is rarely sufficient. Instead, how we approach those questions – and most importantly, how we review them afterward – matters more.

Specifically, remember the equation:

Final Expected Score = Probability of Getting Each Question Correct * Total Questions

Most people focus on increasing the amount of material that they “cover.” I say “cover” in quotations because when we rush, we rarely give ourselves enough time to learn it to the level needed to get questions right on it.

Instead of trying to cover MORE, ask yourself, “how can I improve the probability of getting each question correct?” What you’ll find is that the most significant opportunities are often in:

  • Mastering more material,
  • Improving your recognition (diagnosis AND the significance of every sentence), and
  • Reducing/eliminating unforced errors

What do you think? What has worked – or not worked – with your UWorld or other QBank reviews? Let us know in the comments!

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Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.

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