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From 136 to Step 1 247: Conquer Memorization for Impressive Boards Scores

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by Ahmed Hassan in Plan, Yousmlers


Your residency affects every aspect of your future: your salary, your free time, even how others think of you. Research shows that the most competitive specialties pay the most, and/or have the most free time. It’s no wonder that USMLE scores keep climbing in the continued arms race to stand out.

Nearly 50% of all residency applications don’t get read, usually because of low Boards scores.

You may wonder how to stand out. If you are aiming for a highly competitive residency, you may even wonder if you should settle and compromise your dream residency and set your sights lower. But it doesn’t matter if you are trying for top scores or primarily concerned with mastering medicine, the stakes are always high, and your mastery of concepts are the key.

Our hero (we’ll call her “Sleeps Soundly”), was told from Day 1 that she would have to settle, and that her chances were bleak. Why? She is an IMG, the scarlet letter of residency applications.

Even worse, her first NBME score was 136. Read how she:

  • Rejected memorization;
  • Mastered the material so she scored 247 on Step 1;
  • Doesn’t worry anymore about attaining her residency dreams

Before Yousmle

Sleeps Soundly grew up in the US, but her journey took her to Hungary for medical school. There, her exams were an extreme variation of what all med students know: she had to memorize the words of her professors. Literally.

Why? Because they have high-stakes oral exams, where passing depends on your ability to hawk back – often word-for-word – what the professors have taught you.

Like many med students who adapt to high-volume memorization, she did well. Her scores were always near the top of her class. However, deep down, she knew that she didn’t really understand the material. No one around her seemed to mind, and her professors loved her, so she didn’t think much of it.

That is, until she took her first NBME practice exam.

NBME 12—January: 136

Beauty queens are judged based on their looks; to be unattractive strikes at the core of their identity.

Med students aren’t much different. We’ve been valued for our intelligence and high grades for so long, that we start to see our scores as a reflection of our self-worth.

A score this low sent her into a deep spiral. 

She started thinking she would only be able to return to the US as a tourist – not to practice medicine. She’d meant her journey away from home to be temporary, not permanent. How much would she see her family and friends?

It took her some time to calm down and begin considering her options. She decided that the memorization strategies she’d adopted were too powerful to overcome by herself. She needed a guide. Sleeps Soundly scoured scores of USMLE Step 1 tutors, and came across Yousmle, where their simple message resonated with her:

Memorization is the enemy. The USMLEs test your ability to apply important concepts. Don’t let your USMLE scores get in the way of your dreams.

Yousmle Plan: Apply Key Concepts

She decided to commit and go all-in with the personalized plan that includes the online course and one-on-one private tutoringShe had her first session with Alec soon after.

He explained a little-known truth about the USMLEs. Every NBME question writer is given two all-important rules:

      • Rule 1: “Each item should focus on an important concept or testing point.”
      • Rule 2: “Each item should assess application of knowledge, not recall of an isolated fact.”

Translation? Impressive USMLE scores hinge on one thing: applying key concepts.

The strategy was simple: learn to apply key concepts, then never forget what you’ve learned.

He introduced her to spaced repetition through Anki and how it could help her retain information and not have to re-learn it every few weeks. At this point, she wanted to take the exam in August, 7 months away.

Memorization won the early battles

However, memorization was a powerful adversary. As much as she wanted to believe that mastery was the way, she couldn’t give up her old note-taking habits, and embrace the new system. 

She continued to make endless handwritten notes of everything she came across. She didn’t understand what she was writing and never reviewed her notes.

Like Einstein said, insanity is to repeat the same methods and expect different results. After a few months of trying to balance her old study method with the online course and flashcards, she felt that she was spreading herself too thin and not using her time effectively. Another NBME confirmed her suspicions.

NBME 13—June: 163

It was an improvement, but one hardly worth the months she spent trying to get to it.

With her residency prospects fading, she decided she was going to stick to Alec’s methods of mastery over memorization.

The resources she was using at this point included the following:

–          Yousmle Step 1 Anki deck

–          Rapid Review Pathology

–          Pathoma

–          Clinical Microbiology Made Ridiculously Simple

–          Kaplan Lectures

–          Kaplan Qbank

–          USMLE-Rx Qbank

–          First Aid

She used Anki every day for one to two hours and even made her own cards for the minutiae she felt were easily forgotten and some concepts she had trouble with. The biggest time-savers, however, were the Yousmle Anki cards which helped her understand the key concepts she was learning to apply to the Step 1 questions.

She also became much more serious about attending the live online course sessions. The time difference and her school schedule made it difficult to attend the lectures in real time, but since recordings of Alec’s sessions are available to subscribers, she was always able to catch up.

The lectures rely on questions and discussion between Alec and the students in order to help them master and apply key concepts. Other lectures she watched online were also well-done. However, she grew tired of forgetting everything they had taught.

Yousmle lectures were different. Unlike other lectures, every Yousmle lecture included question and answers that she could immediately copy into her Anki cards [You can see an example here]. She could immediately apply the key concepts she was learning.

She would pause, rewind, and even re-watch entire sessions sometimes when she needed it. She felt that Alec’s way of breaking down and explaining difficult points helped her retain the information much longer than if she just tried to brute-force them into her memory.

Alec also advised her to start working on USMLE-Rx and Kaplan question banks early on. His opinion is that seeing 6,000+ new questions is better than doing UWorld multiple times and seeing the same ~2,200 questions repeated.

Sleeps Soundly kept chipping away for a few more months and managed to do a full pass of both Kaplan and USMLE-RX question banks

She then took the next NBME in early May 2018.

NBME 15—May 2018: 217

Finally in the passing range. The method was working, but she felt that she was still missing questions where she knew the information but ended up choosing the wrong answer. Alec helped her revisit the basics of question interpretation, which helped her reach the all-important stage for getting impressive USMLE scores: applying key concepts.

Her test appointment was confirmed for August. She was going to take it then no matter what happened, but she wanted to see a bigger improvement.

By this point, she had started her dedicated study period and was now focusing on the UW question bank.

NBME 16—June 2018: 219
NBME 17—July 2018: 223
UWSA 1—July 2018: 245

There was a clear upward trend. She was finally feeling confident about tackling the test.

In her last week, she reviewed Anki cards sparingly and focused more on working on her weak points.

Most importantly, she was conquering memorization, and was applying key concepts to every question.

She took the final two assessments shortly before her test.

NBME 19—July 2018: 236
UWSA 2—July 2018: 254

Sleeps Soundly was prepared and anxious to get it over with. 

The test day came and went by in a blur. Like most people, she walked out of the test center in a haze with no idea of how well she did.

After a very long three weeks, she got the email that her score report was available on OASIS. With trembling fingers, she navigated to the website and opened the report.

USMLE Step 1: 247

She had surpassed all of her prior NBMEs. The final score was 111 points higher than her baseline assessment—a massive improvement.

How Yousmle Helped Her Master Key Concepts

Part of mastery is not forgetting old things. For 25+ years, Sleeps Soundly had been content with learning things, forgetting them, then re-learning them when she needed them again. However, the time she wasted re-learning things prevented her from mastering new things.

Instead, she used Anki to never forget things she had learned before. With the time she saved, she learned to apply more key concepts and get such an impressive Step 1 score.

“Could I Have Done Even Better?”

She sleeps well at night, and is very satisfied with the score she ended up getting. However, she feels that she could have gotten the same outcome in a shorter period if she had committed to mastery earlier on.

Conquer Memorization for Impressive Boards Scores

Are you struggling in your battle against memorization? Are you learning how to apply key concepts, or is mindless repetition hindering your residency prospects?

If you are looking to conquer memorization for impressive Boards scores and a fulfilling career, you’re the kind of person we’d love to help.

  1. Jay says:

    If you look at Uworld questions today, you will notice that you rarely get a block where over 50% of the exam takers got over 70% of the questions right. The average correct per question is around 55%. These exams were never about a knowledge. They are trying to confuse you in order to infulence a scale that keeps the US superior regardless of US medical school performance. Years later, I am still toe to toe with current medical students in prep for their steps. I haven’t even started studying. I wasted the final 3 years of my mothers life studying over 12 hours a day, trying to pass a stupid NBME. My score never went up more than a point no matter how well I did in practice. All the while, my family is getting ill and I am watching residents make horrible USMLE tested mistakes with both my mother’s and my brothers care. I do not regret my international education but I have absolutely no faith in the American healthcare.

    1. Alec Palmerton, MD says:

      Hi Jay,

      Thanks for your honest sharing of your experiences. You are very frustrated by feeling like the US has designed a system to keep it at the top, despite US med schools churning out doctors that aren’t providing optimal care to your family. You lack any faith in the healthcare system here. I can only imagine how hard that must be – I’m sorry to hear that.


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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.