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Want to Add 20-60+ Points to Step 1? Here’s How Long It Takes (16 Experiences)

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by Alec Palmerton, MD in Plan, Yousmlers
20-60 Point Step 1 Improvement Calm

Being a medical student is like living on social media. Everyone tries so hard to promote perfect images of themselves.

Tell me if these sound familiar:

  • “I only used First Aid and UWorld and scored 272. If I can do it, you can do it.” (The implication is that they’re a genius because, in truth, no one “only” uses UWorld and First Aid).
  • “Everyone knows you only need 4 weeks to study. Just take your test already!” (Translation: you’re an idiot if you need more time).
  • “My first score was 130. I scored 250 in 5 weeks.” (Look at me, I’m so smart!).

Everywhere we look, med students seemingly breeze through everything. When I was at Stanford, one student would finish every exam an hour earlier than everyone else. In case we didn’t notice him, he loudly picked up his bag and let the door slam shut. Every. Single. Time.

Culture of Invincibility Makes Step 1 Planning Difficult

However, this culture of invincibility in medicine makes Step 1 studying particularly treacherous. Everyone gives you advice, but no one shares their actual scores. And if they do, rarely do you get to see:

  • Their practice test scores, or
  • How long it took to improve

To help you maximize your score improvement, I will share everything. Specifically, I will share 16 USMLE Step 1 experiences how long it took to improve our scores from 20-60+. (Including my own).

In this article, you will learn:

  • Experiences of students who scored 240s, 250s, or 260s
  • How long it took those students to improve their scores by 20-60+ points
  • Whether a low first score dooms you to failure. (Spoiler: it doesn’t, but your approach is key).
  • Failing Step 1 doesn’t mean you’re stupid. (Rather, it’s a problem of approach that can be fixed).
  • Whether NBME scores “plateau”
  • How many students delayed their exams and how much their scores improved afterward
  • Much more

Step 1 240s: 5 Experiences

As a Step 1 tutor, one of the most common goals I hear is “I want a 240.” Why is 240 such a common Step 1 target?

First, the 240s will keep many – if not most – doors open for residency. The average Step 1 scores for the most competitive specialties is typically in the 240s.

More than that, many programs will grant an interview based on a high Step 1 score alone. The 75%ile cut-off for all programs in the survey was in the 240s. In other words, a Step 1 score in the 240s would get you interviews at ~75% of programs with a high-score cut-off for interviews.

As such, you’re probably curious to know more about students who reach the magical Step 1 240. Here are 5 experiences of students who scored 240+ on Step 1, and how long it took them to achieve this.

(To read Get Into a Top Residency: 5 Things You Need to Know, click here).

Step 1 240s Experience: 171 to 241 in 16 Weeks (16 Weeks Dedicated)

Highlights:

  • Non-US IMG. (Graduated from European medical school).
  • UWSA #2 overpredicted final score by 7 points
  • Improved from 221 to 240 by letting go of stress/taking 2 weeks off
  • Step 2 CK score 254
  • In addition to this student’s impressive scores, they also had extensive research experience
  • Matched at Harvard-MEEI for ophthalmology(!)

Step 1 240s - 171 to 242 in 16 Weeks

Here is the same data in tabular form:

WeekScoreForm
0171NBME 12
9.1217NBME 15
12.4221NBME 16
14.6240NBME 17
14.6249UWSA #2
16.4242Step 1

 

This student’s scores improved almost linearly. The only aberration was the 249 on the UWSA #2, which likely was an overprediction. (More on this later).

A note: she improved from 221 to 240 without studying. How? She stopped worrying about her scores, and took 2 weeks off. Think about that next time you tell yourself, “I’ll deal with my anxiety/insomnia later.” It may be one of the key things holding you back.

Step 1 240s Experience: 175 to 241 in 34 Weeks (16 Weeks Dedicated)

Highlights:

  • Non-US IMG (Caribbean student)
  • Initially dedicated study of 8 weeks: 175 to 222
  • Extended for an additional 8 weeks: 222 to 241
  • UWSA #1 overpredicted final score by 17 points
  • Step 2 CK score 251
  • Matched into competitive family medicine program

Step 1 240s - 175 to 241 in 34 Weeks

WeekScoreForm
0175CBSE (School)
8220NBME 12
9.4230CBSE (School)
18202NBME 17
23.1222NBME 13
29228NBME 15
31.4207NBME 16
32.7258UWSA #1
34.4241Step 1

 

Interestingly, this student’s scores dropped toward the middle. (They eventually improved to 241). We’ll never know exactly why. However, because I tutored him, I can offer some insight. Unlike the first student, he wasn’t particularly burned out. However, he stopped focusing so much on question interpretation towards the middle. Instead, he tried to improve his knowledge.

You can read more about this student’s experiences here.

Step 1 240s Experience: 202 to 240 in 12 Weeks (11 Weeks Dedicated)

Highlights:

  • US MD student
  • Initially dedicated study of 5 weeks: 202 to 217
  • However, delayed for another 7 weeks. (Lost 1 week due to hospital orientation. Total dedicated study = 6 weeks): 217 to 240
  • For me, [delaying my exam] was the best choice to make at the time, to get my mental health in check to make sure I was performing as best I could.”
  • UWSA #2 overpredicted score by 5 points
  • Matched at Harvard-BWH in Anesthesiology

Step 1 240s - 202 to 240 in 12 Weeks

WeekScoreForm
0202NBME 13
1.3185NBME 12
3.9217NBME 15
6.3243UWSA #1
8.1243NBME 16
10.4245UWSA #2
10.4234NBME 17
12240Step 1

 

This student delayed their exam, after much thought. After delaying her exam, she improved from 217 to 240.

Interestingly, her scores seemed to plateau in the 240 range over the last 4 weeks. This is a common phenomenon. As you’ll see in the students who scored 250-270 later, often people who break 250+ start with very high NBMEs. It’s uncommon to see students who start with NBMEs less than 220 to end up with a 250+. (Although not unheard of, as you’ll see later).

Step 1 240s Experience: 200 to 245 in 15 Weeks (9 Weeks Dedicated)

Highlights:

  • US IMG (Caribbean student)
  • Dedicated study of 9 weeks
  • Started dedicated study with NBME of 221

Step 1 240s - 200 to 245 in 15 Weeks

WeekScoreForm
0200CBSE (School)
6.6221NBME 7
9.9219NBME 11
11.7232UWSA #1
11.7238UWSA #2
12.9232NBME 12
14241NBME 15
14.9237NBME 16
15.4245Step 1

 

This student started dedicated study with a 221. As a Caribbean student, she had taken a CBSE from her school before her dedicated study began.

Like many students, she continued to improve over time. However, her early improvement was most dramatic. This makes sense: in the beginning, your gaps are more numerous, and you’re less familiar with the exam format. As a result, much more of your studying will help you improve your score. Like many other students here, her score improvement decelerated as time went on.

Step 1 240s Experience: 215 to 246 in 12 Weeks (12 Weeks Dedicated)

Highlights:

  • Non-US IMG (Graduated residency in Pakistan)
  • UWSA #2 overpredicted final score by 8 points
  • Her test was actually canceled by the test center in Pakistan due to facility problems
  • Had to fly to the US to take the exam. (And still scored in the 240s!).

Step 1 240s - 215 to 246 in 12 Weeks

WeekScoreForm
0215NBME 13
1.4240USMLE Rx
7238NBME 15
10252NBME 16
11.9254UWSA #2
11.9242NBME 19
12.1246Step 1

 

This student was an IMG from Pakistan. She had the added difficulty of having her test cancelled last-minute. She’d already committed to doing research in the US, and couldn’t move her flight. She ended up taking her test once she arrived in the US.

Step 1 240s: Take-Aways

Here are the averages for the five students:

  • Average starting score: 192.6 (171 to 215)
  • Average ending score: 242.6 (240 to 246)
  • Total time: 18 weeks (12 to 34.4 weeks)
  • Total dedicated study: 12.9 weeks (9 to 16 weeks)
  • Overall score improvement: 50.2 points (31 to 71 points)

What can we take away from these experiences?

1. People Who Score 240s Often Started in the 200s

While not an absolute truth, many students who end up with scores in the 240s start in the 200s. (Or they study for longer). It’s not hard to see why. Step 1 tests your mastery on a wide range of knowledge. To achieve it, you need to either a) start with a strong foundation, or b) commit to spending the time to build it.

2. Overcoming Stress Should Be Part of Your Study Plan

The first student we highlighted improved from 171 to 242 in 16 weeks. Her jump from 221 to 240 was the most remarkable aspect of her journey, however. She had been working extremely hard and was burned out. In fact, I recommended she take two weeks off and do no studying. She did, and afterward, her NBMEs went from 221 to 240. Translation: she improved 19 points without studying. It was a remarkable jump and highlighted the effects of stress.

Step 1 250s-270s: 5 Experiences

What if you want to shoot for the moon on Step 1? If a Step 1 of 240+ will keep many residency doors open, a score in the 250s or 260s may get you red-carpet treatment. For those interested in the most competitive programs, a score of 250+ will stand out to most residency committees.

In these next profiles, I show you:

  • 5 students who score 250s or 260s on Step 1
  • How long it took us to achieve it
Step 1 250-270s Experience: 236 to 270 in 10 Weeks (10 Weeks Dedicated)

Highlights:

  • In case you were wondering, this was me
  • Stanford University School of Medicine, MD
  • Told by program director I was ranked to match at my top choice (Harvard-MGH Anesthesiology) within a week of interviewing. (I did, indeed, match there).

Step 1 250-270 - 236 to 270 in 10 Weeks

WeekScoreForm
0236NBME 3
2.9259NBME 6
4.9257NBME 11
7.9264NBME 12
8.9265UWSA #1
8.9265UWSA #2
9.9270Step 1

 

My experience is similar to many people who score 250+. I started with relatively high NBMEs (236 in my case). Also, a lot of my score improvement happened early. This was a combination of improvement knowledge and question interpretation.

Most of my improvement after my initial jump from 236 to 259 was due to question interpretation. In other words, while knowledge helped me breach 250+, much of my improvement behind that was avoiding unforced errors.

Step 1 250-270s Experience: 230 to 261 in 14 Weeks (10 Weeks Dedicated)

Highlights:

  • US IMG (Caribbean School)
  • Remarkably, hadn’t used Anki until close to dedicated study
  • However, had begun Boards prep/QBanks nearly a year before dedicated study
  • Dedicated study period of 10 weeks

Step 1 250-270 - 230 to 261 in 14 Weeks

WeekScoreForm
0230CBSE (School)
8.7242NBME 11
12.9254NBME 15
13.4258NBME 16
14.3261Step 1

 

This Caribbean student’s experiences scoring 260+ mirrored mine. He started his dedicated study with a very high NBME score. Remarkably, he hadn’t used Anki until he started working with me close to his dedicated study. Instead, he had a very deep understanding of the body/pathophysiology.

Step 1 250-270s Experience: 226 to 258 in 25 Weeks (5 Weeks Dedicated)

Highlights:

  • US MD
  • Had finished all of Kaplan QBank 1 month before dedicated study began
  • Dedicated study period at med school was only 5 weeks
  • In other words, his NBME at the beginning of dedicated study = 255. (Wow.)

Step 1 250-270 - 226 to 258 in 25 Weeks

 

WeekScoreForm
0226NBME 12
11.9236NBME 13
20.1255NBME 15
21.9259NBME 16
24.3265NBME 17
25.1258Step 1

 

Like the other 250+ students thus far, this student started dedicated study with a very high NBME score. In his case, he only had 5 weeks of dedicated study, and couldn’t extend the date without difficulty. His first NBME was a 255, and his final score was 258. This highlights the difficulty of improving your score the higher you are.

Step 1 250-270s Experience: 217 to 258 in 16 Weeks (6 Weeks Dedicated)

Highlights:

  • US MD
  • Also had finished all of Kaplan QBank 1 month before dedicated study began
  • Dedicated study period at med school was only 6 weeks
  • NBME score at the beginning of dedicated study = 246
  • Read about experience here

Step 1 250-270 - 217 to 258 in 16 Weeks

 

WeekScoreForm
0217NBME 12
5.4240CBSE (School)
8.7246NBME 13
10.4255NBME 15
11.4255NBME 16
12.4246NBME 17
15.6258Step 1

 

Like the previous student, this student started dedicated study with a very high NBME. His first NBME was a 217, however, this was 246 at the time he began his 6-week dedicated study.

Interestingly, his score decreased from 255 to 246, then back up to 258 as his final score. Why? Like with the earlier student, he had strayed from question interpretation. You can read his account here.

Step 1 250-270s Experience: 205 to 257 in 26 Weeks (26 Weeks Dedicated)

Highlights:

  • US IMG (Med School in India)
  • Had previously attempted studying the year prior. (NBMEs had gone from 150 to 167 in a month the year earlier).

Step 1 250-270 - 205 to 257 in 26 Weeks

WeekScoreForm
0205NBME 13
14.4242NBME 15
19.1240NBME 16
20.4248NBME 17
22.7248NBME 19
26.1257Step 1

 

This student’s experiences in many ways mirrored the typical IMG. He had attended med school outside the US. His school had focused largely on memorization. To pass his classes, he’d learned to cram.

Despite being a top student at his school, his first NBME was a dismal 150 the year earlier. He had studied off and on prior to meeting me when his score was a 205.

He quickly adapted to mastery of new material and using Anki to never forget the material. More impressively, he quickly learned question interpretation. His scores skyrocketed, and within 2 months his scores were already in the 240s. Further improving question interpretation allowed him to score a 257 on his final test.

Step 1 250s-270s: Take-Aways

Here are the averages for the five students:

  • Average starting score: 222.8 (205 to 236)
  • Average ending score: 260.8 (257 to 270)
  • Total time: 18 weeks (9.9 to 26.1 weeks)
  • Total dedicated study: 11.4 weeks (5 to 26.1 weeks)
  • Overall score improvement: 38 points (31 to 52 points)

What can we learn from these 250+ scorers’ experiences?

1. Students Who Score 250+ Start with Very High NBMEs

Students who end up with 240s on Step 1 have a variety of starting scores. I’ve had students start as low as the 130s end up with Step 1 scores in the 240s.

However, for those who score 250s on Step 1, typically their starting scores are much higher. The starting NBMEs during dedicated for these 5 students: 236, 246, 230, 255, and 200.

2. However, a Low Starting Score Doesn’t Rule Out a 250+. (But It Likely Will Take Much Longer).

Of the 5 students, only 1 started with an NBME below 200. In his case, his first NBME the year before was 150. (He had studied “off-and-on” for the next year). In this student’s case, however, he ended up with a very strong foundation. As you can see, his results weren’t immediate. Even after starting the Online Course, he studied for 2+ months before taking his next NBME, which was 240+.

Step 1 Fail First Attempt: 2 Experiences

In an ideal world, we’d all like to get 240s or 250s on Step 1. However, most people won’t achieve scores like that. On the other end of the spectrum, people fail Step 1.

Almost every case of a Step 1 fail is due to:

  • Poor approach (usually memorization), which is fixable
  • Not benchmarking well (e.g., taking their first test despite being at high risk of failing)

Let’s look at 2 cases of students who failed Step 1 and later passed.

(To read Fail Step 1, Step 2 CK or CS? Do This, click here).

Step 1 Fail First Attempt: 170 to 187 in 5 Weeks (Before Yousmle)

Highlights:

  • US MD
  • Took popular commercial prep course
  • Reached out to me immediately after failing

Step 1 Pass After Fail - Before Yousmle- 170 to 187 in 5 Weeks

 

WeekScoreForm
0170NBME 11
2.9191NBME 15
3.9191NBME 7
4.6187Step 1 (Failed)

 

Step 1 Pass Second Attempt: 196 to 216 in 10 Weeks (After Yousmle)

Step 1 Pass After Fail - 2nd Attempt- 196 to 216 in 7 Weeks

WeekScoreForm
0196NBME 6
3.4203NBME 12
5.1214NBME 13
5.6198NBME 5
6.7216Step 1 (Passed!)

 

This student’s experiences mirror those of many who fail Step 1. Prior to working with me, she had studied 6+ months using passive learning. She’d paid for videos from a top commercial prep organization, and failed her USMLE Step 1.

We began working together shortly after this student found out they had failed their Step 1 exam.

Fatigue is real. She had taken NBME 5 after a very long day of studying. It shows in the score (198, from 214 previously).  Thankfully it was just a blip; she recovered for the exam.

Her experiences are similar to our next student, who also had a similar trajectory.

Step 1 Fail First Attempt: 160 to 173 in 10 Weeks (Before Yousmle)

Step 1 Pass After Fail - Before Yousmle- 160 to 173 in 10 Weeks

 

WeekScoreForm
0160
UWSA #1, UWSA #2
4.9181NBME 12
6.1183NBME 13
6.9179NBME 11
9.1188NBME 15
9.6194NBME 17
10173Step 1 (Failed)

 

Step 1 Pass After Fail - 2nd Attempt- 184 to 218 in 13 Weeks

 

WeekScoreForm
0184NBME 16
12217NBME 18
13.3218Step 1 (Passed)

 

Step 1 Fail First Attempt: Take-Aways

1. Don’t Take Your Test If You’re Not Ready

Remember, you shouldn’t take your test if you’re not ready. In both cases, these students were borderline passing when they took their test. They both hoped they’d squeak by. They weren’t so lucky.

A fail on any USMLE stays on your record. It will cause some programs to reject you outright.  Neither fail was surprising to these students. There is a chance your score might improve by taking your test when you’re borderline passing. However, are you willing to risk a significant black mark on your residency application to try?

(To read Fail Step 1, Step 2 CK or CS? Do This, click here).

2. Anyone can adapt to the Yousmle Method and continue to improve their scores.

On their first (failed) attempts, both students had long before “plateaued” in their score. However, in both cases, their scores improved significantly from their previous high.

In the first case, she improved from 187 to 216. In the second, he improved from 173 to 218.

Remember, in both cases, students had already completed an entire dedicated study period. Their scores had largely “peaked.” However, after learning to master material and retain it, their scores steadily improved.

Step 1 First NBME Low: 4 Experiences

Step 1 Low First NBME Experience: 136 to 247 in 28 Weeks (10 Weeks Dedicated)

Highlights:

Step 1 Low Starting Score - 136 to 247 in 28 Weeks

 

WeekScoreForm
0136NBME 12
12.9163NBME 13
17.1217NBME 15
21.6219NBME 16
25.9223NBME 17
27.6236NBME 19
27.9247Step 1

 

This was an extreme case of a hard-working student who memorized relentlessly. She had previously crammed buzzwords to study for her school’s exams. Her first NBME was a dramatic wake-up: she scored 136, almost the lowest possible score.

She embarked on a journey to conquer her previous habit of memorization. Her result – improving 110+ points – was a testament to what you can do if you understand rather than cram.

Read about her experiences here.

Step 1 Low First NBME Experience: 161 to 237 in 17 Weeks (17 Weeks Dedicated)

Highlights:

  • US MD
  • “Always been a poor test taker”
  • Originally planned to have 10 weeks dedicated: 161 to 205
  • However, extended by another 7 weeks: 205 to 237

Step 1 Low Starting Score - 161 to 237 in 17 Weeks

 

WeekScoreForm
0161NBME 13
6.3196NBME 17
8.3205NBME 18
9.4205NBME 16
10.9232UWSA #2
15.6238NBME 15
16.9237Step 1

 

This is a pretty common scenario. Someone comes to me and says, “I’ve never been good at standardized tests.” They’re always had good grades, but for whatever reason, they struggle with standardized exams.

She started her dedicated study with a score of 161. Most people in this case would panic and start cramming. Instead, we worked to improve her approach. Instead of rushing, we slowed down. She took time to master material, rather than memorize it.

Her results speak to the improvement that is possible. She continued to improve, from a 161 to a 205 by the time her original 10 weeks was up. Because of her improvement, she delayed her exam for another 1.5 months. Her final Step 1 score was 237.

This is another example of how important it is to slow down. If she’d rushed through First Aid during her first two months, she would have likely stalled much lower. Instead, by giving herself enough time, she was able to master and apply the material. Her 76-point improvement was testament to her deep understanding of the body.

Step 1 Low First NBME Experience: 164 to 220 in 13 Weeks (13 Weeks Dedicated)

Highlights:

  • US MD
  • 13 Weeks Dedicated
  • Initially intended to study for 7 weeks: 164 to 200
  • Extended by 6 weeks: 200 to 220

Step 1 Low Starting Score - 164 to 220 in 13 Weeks

 

WeekScoreForm
0164NBME 17
2.7198NBME 13
3.7179NBME 15
4.7200NBME 16
8.9209NBME 12
12.1213NBME 18
13.1220Step 1

 

Here is another student who started well below passing. Like the others with low initial NBMEs, she had crammed her way through med school. However, by slowing down and mastering material, she was able to gradually improve her score. She ultimately scored a 220 on Step 1 after delaying for an extra month.

Step 1 Low First NBME Experience: 168 to 228 in 10 Weeks (10 Weeks Dedicated)

Highlights:

Step 1 Low Starting Score - 168 to 228 in 10 Weeks

WeekScoreForm
0168CBSE (School)
2190NBME 15
3.1186NBME 12
4.9188NBME 18
6.9207NBME 17
8.4217NBME 16
9.9228Step 1

 

This was one of the few students who had a low first NBME but couldn’t delay their exam. Unlike other people in this position, she still didn’t rush. Instead, she focused on mastering the material. Ultimately she improved her score by 60 points in 2 months.

Her experience demonstrates how changing your approach for Step 1 can pay dividends for your future exams. While her Step 1 score was 228, she continued the approach of mastery and application. Her Step 2 CK score was a 261, a far cry from her first NBME of 168.

Remember, it’s never too late to improve your approach.

Low First NBME Experience Take-Aways

Here are the averages for the four students who started with low NBMEs:

  • Average starting score: 157.3 (136 to 168)
  • Average ending score: 233 (228 to 247)
  • Total time: 17 weeks (9.9 to 27.9 weeks)
  • Total dedicated study: 12.5 weeks (9.9 to 16.9 weeks)
  • Overall score improvement: 75.8 points (56 to 111 points)

What can we take away from these students’ experiences?

1. Don’t Memorize

Virtually everyone starting with a low NBME had previously crammed/memorized. Cramming works well for med school exams, which tend to test facts. The USMLEs focus on mastery and application of content. Memorization for Step 1 is a bad idea. (The NBME even says so).

2. If Your First NBME is Low, Your First Instinct is to Rush. However, That Is Almost Always a Bad Idea.

The numbers don’t tell the entire story. Most people with low NBMEs immediately panic. Then they rush and try to cram large amounts of information.

Rushing is almost always a bad idea. (See above). If the USMLEs test your understanding, then memorization is a poor approach. Instead, slow down, and master material. You’ll end up with a higher Step 1 score. And it will set you up even better for the future.

3. Improving Your Approach for Step 1 Sets You Up for Future Success

To continue on the previous point: mastery will help with Step 1, but also future exams. Many students built on their Step 1 success and did even better on Step 2 CK.

Don’t believe the people who say that Step 1 material doesn’t matter for Step 2 CK. Step 1 material makes up the bulk of what you’ll see on internal medicine. And the internal medicine portion of Step 2 CK is the largest, by far.

20-60 Point Step 1 Improvement Calm

Improving your score by 20-60 points may induce panic. Fight the urge to panic, and take the time to master the material well the first time.

What Have We Learned?

Reflecting on these 16 experiences, five things stand out:

1. ANYONE Can Adapt These Methods at ANY Time in Their Preparation

We’ve seen that mastery, retention, and application work for anyone, including if you are

  • Starting your first year/summer of medical school,
  • At the start of your dedicated study,
  • Have an extremely low NBME to start,
  • Aiming for a 260+, or
  • Attempting to re-take your exam.

Having tutored dozens of students in their USMLE preparations, one thing is clear. It is never too late to stop the cycle of mindless memorization and passive learning.

The key is to give yourself enough time. Remember, cramming leads to weak understanding. And you won’t see much improvement in your score unless you understand the concepts.

2. Looking for a 20-40 Point Improvement? Expect at Least 3-4 Weeks (and possibly more)

The results varied in these 16 cases. (Your results will vary, too). That said, a 20-40 point increase is substantial, and will likely take at least 3-4 weeks.

If you’re thinking you need more time, balance the possibility of gain vs. the cost of extra time studying. It is a personal decision whether and how much to delay one’s exam. Personally, I would probably spend even longer to make sure that I was scoring above my target score (probably in the 4-6 week range). And if I wanted to target a higher increase, I would likely give myself even more time (6-8 weeks, at least).

You might find yourself improving at a much faster rate. I’ve had students improve 60-70 points in ~2 months. However, I wouldn’t bet that I would improve my score that quickly. Instead, to prevent the stress of trying to do too much in too little time, give yourself enough time from the outset.

3. Every Single Student Who Delayed Their Exam Improved. Average Improvement = 23.5 points.

Of the ten US/Caribbean medical students, four delayed their exams. Average scores Improved by > 1 SD. The four students who delayed pushed their test back:

Most of the students who chose not to delay their exams did so because they were happy with their score. One student wished she could have delayed her exam. However, she couldn’t do so without delaying her graduation. (She later made up for it by scoring 261 on Step 2 CK).

When these students delayed their test, their scores continued to increase. Delaying their tests gave them less elective time during clerkships. However, if they made the decision again, most would do it without hesitation.

(To read Are You Ready to Take Your USMLE or Need More Time?, click here).

4. Failing Exams = Bad Approach, Not Lack of Ability

Most students get frustrated with low scores and think there is something wrong with them. Self-doubt is even worse if you’ve failed Step 1 or another USMLE.

Remember the students who had previously failed, but then improved their scores by 30-40 points? These methods could be adapted even after someone had reached an apparent plateau and has even failed their exam.

So many medical students follow the pattern of

  • Never finding an effective learning strategy, and
  • Relying on memorization/cramming

Even after two years of following this dead-end strategy, I’ve seen numerous students improve their scores substantially by following the continuous cycle of:

  • Learning for understanding,
  • Making sure to never forget the information, and
  • Learning how to apply it to USMLE questions
5. Your Score “Plateau” is Likely Higher Than You Think

Few if any of these students reached a score “plateau” as is so often described by other students. Why might that be?

Most students describe hitting a “plateau” in their score. This is described as when the amount of knowledge they gain every day is balanced by the amount of knowledge they forget. The beauty of using spaced repetition is that you will never forget what you learn. As we can see in these 16 examples, none of us really reaches a “plateau” in our knowledge.

You will notice, however, that it becomes harder to improve your score beyond 240 and 250. Why? In my experience, to get to a 230-240, it takes solid knowledge. However, to score 240+, you have to reduce unforced errors. In other words, higher scores don’t require better knowledge, but rather better application.

(To read The Secret to Scoring 250/260+ You Can Learn Right Now: Question Interpretation, click here).

Concluding Thoughts

You may be wondering how long it will take for you to improve your score by 20-40 points. As these 16 cases illustrate, there’s no easy answer.

The thing I can tell you with certainty: rushing/cramming is the wrong approach. Most people have disappointing first scores because their foundation is weak. Rushing through UWorld and First Aid without developing mastery will leave you stuck in the same place.

Remember this equation:

1 month + 1 month + 1 month rushed studying ≠ 3 months calm, focused studying

I shared these 16 experiences to show you that reliable, durable improvement requires mastery. Mastery requires time. Give yourself enough time, and you can reap the benefits in higher USMLE scores and a happier future practice.

Do these results and timelines seem attainable? Does this seem like a reasonable approach? Let us know in the comments!

Photo by Indian Yogi (Yogi Madhav)

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