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USMLE Studying Should Take Longer Than You Expect. Here’s Why.

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by Alec Palmerton, MD in Plan
USMLE Timeline Insomnia

USMLE scores are high stakes for getting into your dream residency. Yet few students achieve their goal USMLE score. Why? We’ve discussed at length how poor study strategy will handicap your USMLE ceiling. Specifically, many students focus on cramming details rather than understanding and applying concepts.

However, lots of hard-working students still fall short of their potential. Why? They don’t give themselves enough time to study. Specifically, most students have unrealistic expectations of:

  • Their goal score
  • How long it will take to achieve it

These two things are inter-related. More problematic? Unrealistic expectations can lead you to a lower score.

In other words, cramming over a short period will hurt your USMLE score.

Today you will learn:

  • Why students systematically underestimate how long USMLE studying should take
  • How giving yourself too little time to study will cause your score to stagnate
  • Why making the decision early helps you increase your score more
  • Why it’s even better to have enough time to study from the outset
  • How to figure out how much study time is reasonable

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

Planning Fallacy (AKA People Suck At Making Predictions)

How accurate is your prediction of how long you’ll need to study for the USMLE? If you’re like most people, you likely underestimate how much time you’ll need to study. (And likely underestimate it by a lot).

It turns out, people are bad at making predictions. Here are a few examples, from “Thinking, Fast and Slow” by Daniel Kahneman:

“In 2002, a survey of American homeowners who had remodeled their kitchens found that, on average, they had expected the job to cost $18,658; in fact, they ended up paying an average of $38,769.

A 2005 study examined rail projects undertaken worldwide between 1969 and 1998. In more than 90% of the cases, the number of passengers projected to use the system was overestimated. Even though these passenger shortfalls were widely publicized, forecasts did not improve over those thirty years; on average, planners overestimated how many people would use the new rail projects by 106%, and the average cost overrun was 45%. As more evidence accumulated, the experts did not become more reliant on it.”

People are so bad at making predictions, in fact, that social psychologists have a name for it. Kahneman labels this phenomenon the “planning fallacy.” These unrealistic predictions are:

  • “Unrealistically close to best-case scenarios
  • Could be improved by consulting the statistics of similar cases”

Translation: people assume rosy, best-case scenarios when making their plans. Because of their unrealistic expectations, their plans are often wildly inaccurate.

Next, we’ll discuss how med students fall prey to the planning fallacy in their USMLE studies.

Med Student Planning Fallacy: Unrealistically Short USMLE Timelines

It’s not just homeowners and rail project managers with unrealistic expectations. Med students also fall prey to the planning fallacy. Nowhere is this more evident in how long students think they need to study for the USMLEs.

When I was a med student at Stanford, at least 1/3 of students ended up delaying their test. In other words, more than 30% of students underestimated how long studying would take. I’ve tutored hundreds of students, and the trend is true in other schools as well.

We just discussed why most students have unrealistic USMLE timelines. Now, I’ll explain why having an unrealistic timeline actually hurts your USMLE performance.

Unrealistic Timelines → Slow USMLE Improvement

A favorite story of mine goes something like this:

An apprentice (A) visits a master swordsman (MS).

  • Apprentice: I’d like to become a master swordsman.
  • Master swordsman: Great, it’ll take you 10 years.
  • A: What?? 10 years?? I’ve only got 5 years – you’ll have to teach me in 5 years.
  • MS: OK, now it’ll take 15 years.
  • A: (apoplectic) 15 years?!?! You just said 10!
  • MS: Yes, but you’re in a rush. It will take you longer.

This story illustrates the importance of not rushing. There are numerous reasons why rushing makes you less efficient. One of the biggest reasons: by rushing, you have to re-do your work.

Rushing is the #1 most common mistake I see students make. What do you do when your score is dramatically below what you hoped? You rush. But by rushing, you don’t learn the material properly. You’re “covering” lots of First Aid pages, but how much can you apply to questions? Not a lot.

(To read The Worst Mistake Students Make with First Aid for the USMLE Step 1, click here).

When your scores stagnate, do you slow down? Of course not! You speed up and try to do even more UWorld questions every day.

The tell-tale sign of someone rushing is to look at their schedule. It usually looks like:

  • 1-month cramming, then you realize you’re still not ready. Delay for 1 month.
  • 1 month more cramming. Still not ready. Delay another month.
  • 1 month more cramming. Cycle repeats.

Remember, cramming for 3 months is NOT the same as mastering material every day for 3 months. In other words:

1 month + 1 month + 1 month ≠ 3 months studying planned in advance

How You Know If Your Timeline is Unrealistic

How do you know if your timeline is unrealistic? If you’re in/are approaching your dedicated studying, you probably have a good idea. Specifically, do you feel like you:

  • Don’t have enough time to learn things properly
  • Have trouble sleeping
  • Feel overwhelmed by the number of things you need to cover
  • Wonder how you can possibly cram everything in?

This is not an exhaustive list. However, these are typical signs you may be rushing because of unrealistic expectations.

Unrealistic timelines hurt your USMLE performance by forcing you to cut corners. Next, we’ll discuss how to make better estimates for how long studying will take.

USMLE Timeline Insomnia

So stressed by your USMLE studying you can’t sleep? It might be a sign you’re rushing because of a timeline that’s too short.

The solution to the Planning Fallacy: Start with the “Outside View”

By expecting the best-case scenarios for score improvement, our timelines are unrealistic. So how do we make better estimates for how long our studying will take? By using what statisticians call the “outside view.”

The outside view means looking at a group of students with similar characteristics. Then you use individual factors to modify that estimate.

In other words, look at groups of students with similar starting scores. Use their timeline as a starting point to estimate how long it’ll take you. Then use specific details about your situation to adjust from the base rate.

For example, if you were starting at around 190, and wanted a 240, you could expect it might take 3-4 months. (See below for representative samples from students I’ve worked with). If you were only able to study part-time, you should expect to take more time. If you could study full-time throughout, you could expect it to take less time.

Again, using “outside view” information doesn’t guarantee an accurate prediction. However, by using a reference group to create your forecast, you improve your chances.

Here are examples from students I tutored. Note: I chose them as a representative sample because I knew them personally. I worked personally with these students to help them. (The average improvement for students from the time I start tutoring them is 50+ points). The timeframes involved are not all dedicated studying. Thus, if you will have only dedicated studying, you could expect it to take less time. Finally, if you won’t have the benefit of a tutor, you might expect it to take longer.

(These examples were taken from the following article.)

How Long Would It Take to Score 240s?

For example, for 5 recent students I had who ended up with scores in the 240s, this was how long it took:

  • 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)

Note that the 18-week average wasn’t all dedicated study time. (The student who took 34.4 weeks, for example, only had 16 weeks of dedicated study). If you were planning on having only dedicated time, then, it might take you less than 18 weeks. However, using 18 weeks is a good starting point, especially if your starting score is around 190s.

How Long Would It Take to Score 250s?

I looked at 5 students who had scored between 250-270, to see what the base-rate might look like. Here are the statistics:

  • 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 does this tell you? Again, it gives you a starting point for what a realistic timeline might look like if you wanted to score 250. (It also gives you a sense of where you’d want to start). Just like the other examples used, not all of this study time was dedicated study. So if you had only dedicated study, you might expect it to take less time.

What Might a Realistic Timeline Look Like for a Low Starting NBME?

What if your first NBME is well below passing? Here are 4 such students:

  • 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)

Again, does this guarantee you similar results? No. However, it gives you a starting place to estimate how long you might need.

It’s Hard to Get an Extended Timeline Early On (But It’s Worth Fighting For)

Most US med schools have dedicated study periods of a predetermined length. When I was at Stanford, ours was about 8 weeks. I’ve seen anywhere from 4-12 weeks, with most being around 2 months. What most students don’t realize is that these study periods are malleable, and can be extended.

Just because it’s possible, however, doesn’t mean getting extra time from your school is easy.

Most schools are reluctant to give extensions for USMLEs (particularly Step 1). This is doubly true if you’re asking for an extension a month out from your USMLE! They’ll (politely) accuse you of being dramatic. They’ll say, “oh, just see how you’ll do.”

Administrators have valid reasons for being wary of students delaying their USMLEs. Yes, it’s an administrative hassle. However, they are also likely thinking of past experiences with other students. The pool of students who have delayed their test in the past will overrepresent students:

  • With poor study plans
  • At high risk of failing their exams
  • With other barriers to studying

Yes, it’s hard to get an extension of the typical study period from most schools. However, that doesn’t mean you shouldn’t do it. As we discussed before, it’s critical to have adequate time to study. Otherwise, you’ll risk rushing and never learn to apply the information on your exam.

It’s particularly important to get an extension if you are at risk of passing. There is no good reason to take your test if you might fail.

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

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

Concluding Thoughts

Most people take the USMLEs only once. It might seem like a tall order to determine what a realistic study timeline would be. However, a reasonable starting timeline is critical. Having too little time will cause you to rush and waste time.

Remember:

Cramming 1-month x 3 ≠ 3 months purposeful mastery of the material

Starting with an appropriate timeline will make you calm and maximize your score.

What do you think? Do you think 3 months of cramming is equivalent to 3 months of purposeful mastery? What is the best way to generate a reasonable USMLE study timeline? Let us know in the comments!

Photo by Alexandra Gorn.

Want FREE Cardiology Flashcards?

Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored 270 on the USMLE Step 1 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.

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