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UWorld: Overcoming 6 “Fails” to a USMLE 260

A New Hope/Way to Approach QBanks

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by Melody in Plan, Yousmlers

Ask any student who’s scored a 260 on the USMLE what question bank they used, and they will say UWorld.  Ask any student who’s scored a 160 what question bank they used?  UWorld.  What does this mean?  While UWorld is a fantastic resource, just doing it isn’t enough.  Instead, how you USE it is absolutely critical.  Just ask Melody, who completely changed her approach to using UWorld to go from a Step 1 226 to a Step 2 260 and interview a number of her “dream” residency programs.  Here she shares her thoughts on her biggest mistakes in using UWorld, and how to overcome them.  -Alec

I want to talk about my experiences with utilizing question banks, and how they went from having dementor-like properties to being a source of light and hope. Let’s first slog through the painfully large number of mistakes I made so you can hopefully learn off them.

Failed Approach #1: Mastering material without working on retention

I tried to start UWorld near the beginning of M2 year. My thought process was that I would get through all the questions once by end of the year before starting dedicated time and doing it again (since everyone knows you have to do UWorld twice *sarcasm*). Though this is one approach that can work, I did not implement it correctly. I ended up doing only a few half-blocks here and there for only some of the blocks. Even though I thoroughly went over those, by the end of the year I had completely forgot what I had learned and those very same questions looked foreign to me. I was not using Anki at the time and will go over that point in the second half of this article.

Fail #2: Inefficient block reviewing

I would spend way too long going over blocks. I would have a goal of doing 1 timed block for 1 hour, then 1-2 hours to review. However, often I had a hard time trying to pick out what was important. I would end up thinking that every one of the wrong answer explanations was important, and get sucked into looking every unknown thing up and then trying to remember it. 1 block would sometimes take me up to 3-4 hours to review! (I’m looking at you, cardiology).

This was a constant frustration for me – I would set a study schedule, fall behind, redo study schedule.

As a result, I would freak out about being behind and then try to rush through other questions, just memorizing instead of trying to understand. Talk about a vicious cycle.

Fail #3: Wasting time taking detailed notes

As a follow up to the above – I spent a lot of time taking detailed notes in First Aid, and drawing concepts or charts out from the answer explanations. It made me feel productive back then (I love color coded notes!) but took wayyy too long and I would forget the majority of it anyways!

Fail #4: Continuing to follow a study technique that was not working

Going down a rabbit hole and wasting tons of time on a random study tactic. This is my example, but there are many others that you might be doing: One of my friends told me she had taken a note log and would write the key point for almost every question. Then she would read through her ever-growing log once a week. I decided this sounded like a good idea at the time and started doing it. Then I kept doing it. I ended up spending so much time on this that it got overwhelming, and I barely even looked at this later on.

Lesson: if you know a study technique is not working, just STOP IT, reevaluate, and figure out a new approach. Don’t keep going because you have been doing it for so long.

Fail #5: Procrastinating on taking NBMEs regularly

I kept putting off taking NBMEs because I wanted to get through just a bit more material, in order to have a better practice score (why? to feel better about myself? womp womp, this usually failed).

Guess what? They are practice scores for a reason! It is not your final result. You need to take NBME’s on a regular basis in order to constantly evaluate your progress and shore up your weak areas. Think of it as high-yield studying… if you spend equal time on all subjects including your strong ones, you are not going to get many more points on those strong sections. You will see a bigger jump in scores if you distribute more time to your weakest subjects in order to bring balance to all topics.

Likewise, don’t get disheartened at getting chunks of UWorld wrong or a low block % compared to the average reported/your friends. Your main goal is to LEARN off UWorld in two ways – to become a master question interpreter, and to learn important concepts.

Fail #6: Redoing UWorld

I reset UWorld and then redid it in order to have another pass of timed blocks. In theory, this sounded great.  However, since I had done many of the questions close to when I reset it, I kept seeing ones that I automatically knew the answer to! This was a time waster at the expense of seeing new questions from another qbank. Also, I had flagged some questions that had great explanations or concepts that I wanted to refer back to, and now my entire past history was wiped and I couldn’t get to them again. Le sigh.

P.S. Looking back on the above makes me do this –> O.o     ……..     T_T

Okay, now we’ve gone through the major things I did wrong. What now? First, this quote –

“Fear is the path to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.”

Don’t fear Step 1, and don’t hate Qbanks… understand them, then use them to your advantage:

And now, here is my step-wise advice to approaching Step 1 throughout M1-2 year and into dedicated study time:

1) Start of each new class

  • Do relevant Anki cards from Step 1 deck. I personally recommend 15-25 new ones/day, no more.
  • M1 Year: you can do the Biochem, Genetics, Stats, Histo, and Immuno decks
  • M2 Year: do relevant Step 1 deck and Pharm deck for each organ system.
  • *If you only started using Anki in M2 year, that’s okay, you can either pull related cards from the above decks into each organ system deck and incorporate them over the year, or on lighter classes make it a point to learn an additional complete M1 deck topic.

2) Core learning

  • Learn from lectures according to what has worked for you, really making an effort to understand pathogenesis to presentation. Reference First Aid and the premade Anki cards to figure out what is most important, but doing well in classes means you have to learn much more detailed info than just what’s in those two resources! Don’t fall into the trap of thinking that you shouldn’t try hard for classes since preclinical grades/honors don’t matter. Sure they have much less weight when it comes to applying for residency, BUT you will need this deeper level knowledge to draw on if you really want to go from jedi apprentice to master-level Step 1 score.

3) Incorporate a Qbank starting M2 year

  • Flag questions that had good learning concepts, charts, or pictures so you can refer to them later if you want, which saves time from you copying down the info somewhere else. I had a Word doc with the question IDs and name of topic under the overarching Organ system. Don’t get carried away though!
  • Whatever approach you take and wherever you are in your studying, it is crucial to remember the key info you have spent time learning with Anki cards! This will save you so much time later from having to constantly relearn it. However, do NOT include every thing from class into your deck. Create a separate deck for cards from your classes so you won’t overload the original Yousmle Step decks. Only add concepts from UWorld into the Yousmle Step decks directly.
  • If you find yourself spending way too long trying to understand certain questions or trouble concepts, make a note of that question/concept in a list and move on. Then go over them all at once in a session with a professor or tutor to be more efficient.
  • When you correct each question, ask yourself why you got it wrong. Was it from misinterpretation or lack of knowledge? Constantly work on improving your technique and understanding the key concepts. This is how you get better, and where you will see your scores start going up and up.
  • Question approach is SO IMPORTANT. Each question is another opportunity to practice becoming a better test taker. This is what I worked on over a full year during my tutor sessions with Alec. You need to read each sentence of the question stem and figure out how it contributes to the overall presentation. Then order the events into the correct timeline, simplify the stem into a specific question, and answer it. Lastly, explain to yourself why the other options are wrong. This is not easy to explain, nor is it easy to learn to do properly, which is why I recommend at least one session with Alec to really understand this critical approach.
  • Aim to finish most of UWorld, and figure out your schedule accordingly. If you don’t end up using two Qbanks and only have time to do one, just focus on UWorld.
  • In the beginning you can either do blocks timed or on tutor mode, and in smaller chunks. By the 2nd half of dedicated time at the latest, do all full-sized blocks timed.
  • I would recommend using two qbanks and not resetting either. You can either do class-specific blocks of Kaplan throughout the year (start in the second half of each class so you have some foundation of knowledge, and don’t worry about finishing it all by any means), then do Uworld near the end of the year and for your dedicated time. OR, you can do the opposite and do some UWorld blocks, finish it during dedicated time, and go through Kaplan focusing on your weak sections first.

4) Practice tests

Take a baseline NBME near the end of the year or at the start of dedicated time. Take one every 1-2 weeks! I also recommend spending one day and take two in a row to simulate time and length of a test, in order to build endurance and figure out how to time breaks and caffeine intake

Okay, I think I covered everything. If you have any questions or want further clarification, I’ll be happy to answer!

May the force be with you.

– Melody

  1. John Carlo Combista says:


    1. Yousmle says:

      It is possible, but it is highly competitive. You can see outcomes here:

      Anki is a program that uses spaced repetition to help you to never forget what you’ve learned in the most efficient way possible. Because of this, showing you cards at specific intervals, timed to force you to review cards at the times you are most likely to forget the information. By reviewing that information, you not only recall that information, but extend the period of time over which you will remember it. Because of this remarkable fact, if you do your cards regularly, with a reasonable number of new cards that you learn every day, as well as finishing all of the old reviews that are due on a particular day, you can recall an enormous body of information, with comparatively small effort.

      As such, the key is to start as early as possible to get the most out of it. You have access indefinitely, so there is no reason to delay.

      As an example, because I’ve done this for the last 8+ years of my life, by only reviewing roughly an hour every day, I can recall the information in more than 20,000 flashcards, since only roughly 100 old reviews are due on any particular day. But how can you use this remarkable technique for yourself? You have to start slowly. You can certainly make your own cards, which eventually you may want to try. However, in the beginning, to give yourself the best chance of success, I would recommend that you use the cards by starting with your weakest subjects. The decks are already divided into specific blocks, like cardiology, respiratory, biochemistry, and genetics. Do roughly 50 new cards total from all decks, and make sure that you review all old cards that come up for review in any given day. You can supplement this by making cards of your own, or you can just use the cards that I’ve prepared for you!

      To find out more, go to

      For other resources I recommend, go here:

      1. John Carlo Combista says:


        1. Yousmle says:

          I’m working on a more effective way to send updates to the decks – I hope to have a better system in place by the time you get the decks!

  2. Medstudent says:

    Hi Melody, this article and the previous ones are great! Congrats in your achievements! This one, I feel like I wrote it myself (especially fail #2 and fail #5). The following are my available (unused Qbanks): ~40% Kaplan and ~20% UW. (2) Kaplan Self Assessments; NBMEs 16, 17, 18 (did 12,13,15 – not even close to my goal). After reading many of Alec’s articles I decided to use Kaplan Q-bank by systems to master weaknesses and planned to use what I have left of U-World for the last weeks of dedicated study time.
    Q#1 – What do you recommend regarding how should I use the Q Banks and NBMEs I have left, lets say for a 65 day period? #2) Should I purchase UW forms as well? #3) Also, after I take an NBME or any other practice exam, how should I schedule my weak subjects? Any other suggestions are more than welcome. Thank you in advance for your time and sharing!

    1. Melody says:

      Hi, thanks for writing in!

      For NBME’s, when was the last time you took one? If it was longer than 2 weeks ago I would do one ASAP. Do NBME 16. Also, I am not sure how you reviewed the other ones but make sure to go over it and actually understand why you missed each of the questions (content vs. misinterpretation). If you can’t figure it out, meet with someone else who can explain where you went wrong.

      I would focus on UWorld first to ensure you use the best qbank fully, and then do Kaplan once you finish. Don’t try to rush through them for the sake of getting through them, but really try to hone in on improvement.

      Are you using Anki? It is not too late to start! Do NOT try to add a ton in the beginning to back-track and catch up, because you will burn out on those and not make any progress (I did this). Just add related cards every day as you go so it is manageable.

      Here is a rough schedule that you could follow –

      Day 1: Take NBME 16, review. Figure out what you need to work on the most!
      Day 2 to 14: Focus on one weak subject per day, and rotate through each day (in order of weakest to least weak, then repeat). First half of the day, do UWorld mini-blocks of 10-25 questions on that subject. Make sure to focus on test taking skills as listed in my article. When you review, understand the concepts needed in order to get the answer right. If you notice it is something you keep missing, it’s even more important to make sure you nail it down now. Make Anki cards to ensure you don’t forget the key information. Second half of the day, you have the option to do mini-blocks of UWorld mixed questions. If you are doing mixed Anki cards regularly, you can keep doing that weak topic by itself (especially if it is super weak or you feel you didn’t make enough progress/are on a roll from the morning).
      Day 15: Take NBME 17, review. Figure out if your weak areas are still not improving – time to reassess your strategy if so! There is no shame in getting tutoring or help.
      Day 16 to 29: Weak subjects in morning, mixed in afternoon.
      ~Day 30: Take UWorld Self Assessment 1, review. (The nice thing is that they have answer explanations.)
      Day 31 to 49+: Do full, timed blocks. Can either do weak in AM and mixed in PM, or all mixed.
      Sometime between Day 50 to 58, pick a day and do NBME 18 + UWorld Self Assessment 2 back-to-back in order to simulate the real test. Pay attention to when your brain starts fatiguing, and between which blocks you would want to take mini-breaks at your desk versus leaving the room to take some sips of caffeine/stretch. Review it the next day. (Note: The later NBME’s have longer question stems so it gives you a better idea of timing per question per block. When I took Step 1, UW SA 2 was known to have an easier grading scale, so the two tests next to each other balanced out).
      Last week(s): Do full, timed, mixed blocks. If you are only doing Kaplan at this point and are worried about format being different, you can also go over some of your flagged UWorld questions briefly every day.
      Day 64: Just review Anki cards or some high-yield points, do something relaxing and/or fun. Get a massage, eat some chocolate cake, get some rest! Pack your stuff so it’s ready to go in the morning. Know that you did everything you could.
      Day 65: Test Day – Good luck!!

      Let me know if this makes sense, or if you have any other questions at any point until your test 🙂


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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.