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UWorld FAQ from a Harvard-Trained Tutor Who Scored 270

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by Alec Palmerton, MD in Plan
UWorld Strategy Wrong

UWorld (sometimes called “UW”) is one of the most widely-used question banks (“QBanks”) for Step 1, Step 2, and Step 3 prep. Formerly known as “USMLE World,” its popularity has led to a lot of dogma around how best to use it. Despite scoring 270 (99.9%ile) on Step 1 at Stanford, I made many mistakes using UWorld, partly by blindly following the “standard” advice. In this article, I’ll answer the most common questions surrounding the QBank. Plus, I’ll tell you the biggest UWorld mistakes and how to get higher Step 1 and Step 2 scores faster. (Even in a world where Step 1 is pass-fail).


  • UWorld has changed a lot over the past 10+ years (e.g., the number of questions has doubled, and the quality of questions has been diluted somewhat)
  • The USMLEs have changed a lot (e.g., Step 1 is pass-fail)
  • However, UWorld advice has largely stayed the same (e.g., “do lots of UWorld questions,” “repeat UWorld many times”)
  • Most people are afraid of leaving the herd; those who can do so thoughtfully can improve their Step 1 and Step 2 scores faster


Note: this article was updated on 11/17/2023 to reflect:

Table of Contents

Question #1: What is UWorld (or “Youworld”)? Why Is It So Famous?

tl;dr: UWorld is a question bank of USMLE practice questions. The quality has fallen in recent years. However, it is famous because it is still the best at mimicking the concept-application style of Step 1, Step 2, and Step 3 questions.

UWorld is a question bank (or “QBank”), composed of practice questions for the USMLE Step 1, Step 2, and Step 3. (It has also expanded into other exams; this article will focus on the USMLEs).

To do well on any exam, we must practice for it, right? This practice – and how we do it – is doubly important for the USMLEs. That is because the USMLEs are written as tests of concept application, NOT factual recall.

Unlike the exams most of us take in medical school, Step 1, Step 2, and Step 3 focus on applying medical principles. Thus, the question bank we choose significantly impacts our skills of question interpretation and concept application. UWorld is famous because it has traditionally been the best at mimicking the USMLE style of questions.

Question #2: Should I Repeat UWorld Step 1 Multiple Times? (Even At the Expense of Another QBank)?

tl;dr: UWorld is great for testing you on applying concepts you’ve mastered. However, rather than testing yourself using the same question 2-3x, use a fresh QBank. (Especially since UWorld has more than doubled the number of questions from when people started saying to repeat the QBank).

When I entered Stanford in 2009, the most common advice I heard was to repeat UWorld multiple times. At the time, UWorld Step 1 had fewer than 2,000 questions. Today, that number is nearly double! Yet all I hear students say is, “You have to do multiple passes of UWorld!!” Let that sink in. If doing a 2,000-item QBank twice is 4,000 questions, why would I do it twice if the QBank is now 4,000 items? I’ve seen that this multiple-UWorld-passes advice gets passed on as gospel because we’re afraid of deviating from “the path.” But why would people want to repeat UWorld? And why might that be a mistake?

Why Do People Say to Repeat UWorld?

Why does everyone tell you to repeat UWorld? The logic is alluring: UWorld is a fantastic resource. Therefore, doing it more than once will boost your score even further. If a little of something is good, then more must be better. Right?

Repeating UWorld Isn't Better

A little bit of water is good for you. But excessive water isn’t necessarily better.

If Something Is Good, More Isn’t Necessarily Better

Ultimately, I realized repeating UWorld was a mistake when I ran into one problem: opportunity cost. Every repeated UWorld question prevented me from studying from a different question bank. Plus, I remembered so many questions that it gave me a false sense of security that shattered when I saw fresh NBME questions. The USMLEs and Shelf exams test your ability to apply concepts. So yes, practicing by doing QBank questions is critical. But as I discuss below, much of the benefit comes from seeing a question the first time. If you’ve seen a question – particularly recently – it’s easy to remember the answer without remembering the reasoning. Temporarily, you may boost your confidence by seeing higher scores. But that confidence can be shattered when you go to the exam and realize that the questions are written differently than you’ve practiced.

Do UWorld Only Once

UWorld questions are as close to the real thing as possible. Because they’re so close to the real thing, I STOPPED repeating it. Wait, what? A considerable challenge for Step 1 and Step 2 is questions you have never seen before. Some you may have never even thought about. That is the secret to scoring 99.9%ile on Step 1 or Step 2. You must learn how to reason through questions you’ve never seen before. Even if you hope to pass Step 1, knowing how to apply concepts to novel questions can help push you over the top.

How to Prepare for Questions You’ve Never Seen Before

How can you get questions right you’ve never seen before? By practicing questions that you haven’t seen before. This might seem obvious. So why do so few people do it? UWorld is similar to USMLEs. However, that does NOT mean your USMLE will be exactly like every UWorld question. How many students claim their test was nothing like First Aid/UWorld? Lots. But if UWorld is like the USMLE, why are so many students blind-sided? Because they go in thinking the content of the test will be identical to UWorld. Instead, expect the unexpected. Use UWorld (or other QBanks) to simulate never-before-seen questions. Full disclosure: I used Kaplan’s Question Bank first. My NBMEs were in the 250s before I even started UWorld. (I only did 2 Qbanks total). I started to repeat my UWorld questions but stopped when I realized my scores were artificially inflated by remembering questions.

Question #3: Can I Repeat UWorld for Step 2 After Shelf Exams?

tl;dr: yes, but check and ensure you aren’t remembering questions from before.

The one time I HAVE found repeating UWorld questions helpful is if you’re studying for Step 2 after preparing for Shelf exams. Why? Most people use UWorld to study for the Shelf exams after each clerkship. Since clinical rotations last more than a year for most US med students, it will have been many months since they saw specific questions. Especially if it’s been 6+ months since you did them last, they will again feel like “new” questions. And it’s vital that questions feel new. High Step 2 scores depend on your ability to interpret questions. For example, you need to know why a patient with a deviated trachea has hypotension, jugular venous distension, and clear lungs. (E.g., tension pneumothorax with signs of right-sided heart failure). If you remember the answer, you can’t practice putting all the pieces together, a skill you’ll need on the actual exam. So, feel free to repeat UWorld for Step 2 if it’s been many months since you did most of the QBank. (Ensure you aren’t remembering the answers to questions.)

Question #4: When Should I Start Using UWorld?

tl;dr: UWorld has nearly doubled the number of questions; it’s easier to start earlier without repeating them later.

In the olden days, UWorld Step 1 and Step 2 each had fewer than 2,000 questions. Now, each has nearly double that number. To make sure you would only do each QBank once, it was often better to start later in your studies. However, now that there are many more questions, you can start much earlier! As a first-year medical student, you may not be able to answer very many items. However, even doing a few QBank questions daily along with your classes can help, especially since most med school exams are memorization-heavy. Similarly, for Step 2, it is good to start as early as possible. Most of Step 2 will be based on Shelf exam content anyway. As such, the better you prepare for your Shelf exams using UWorld, the easier it will be later.

Question #5: How Similar is UWorld to Step 1 or Step 2?

tl;dr: the “It” factor for QBanks is how well they mimic the NBME style of questions. UWorld is worse than it used to be…but better than the others.

UWorld has always been a reasonable tool for learning. However, what caused it to stand out was that the questions did an excellent job of mimicking the style of Step 1 and Step 2. Does UWorld still do a good job of mimicking NBME-style questions? I’ve seen UWorld questions evolve over the past 15+ years. In my opinion, the questions are worse than they used to be at using the NBME style. (How can you double the number of questions without adding more “filler” type questions?) That said, they are still better than the alternatives, even Amboss or Kaplan.

Question #6: Why Do Some Say Step 1 or Step 2 Are Nothing Like UWorld?

tl;dr: the USMLE test writers are VERY clear: they are testing your ability to apply concepts, NOT memorize facts. If you approach Step 1 or Step 2 like a list of facts to be memorized, you may find your test feels NOTHING like UWorld. If you apply concepts >> memorizing details, the exams will likely feel familiar to UWorld.

Why do so many students who take the test say it was nothing like what they’d prepared for? They say it wasn’t at all like their UWorld questions. But how do others (including myself) claim it was similar to what they’d expected? I’ve worked with multiple students who have failed Step 1 before coming to me. These two groups’ experiences differ because of their beliefs about the test.

UWorld Repeaters Often Believe USMLEs = Tests of Knowledge, Not Application

The students who’ve failed their USMLE often feel that the exam is a test of facts. They think repeating UWorld and First Aid is the best way to accumulate those facts. The high-scorers know covering everything they could be tested on is impossible. Instead, they know that the point of the exam isn’t knowledge. Instead, scoring high on the USMLEs requires the application of principles. High-scorers recognize that memorization itself is insufficient. They must apply that knowledge to interpret the test questions correctly. (To read How Are USMLE Questions Written? 9 Open Secrets for Impressive Boards Scores, click here). The latter group sees the QBank merely as a means to an end. To them, it’s a practice ground to hone their reasoning skills for the test day. In my experience, this group does much better.

UWorld Strategy Wrong

Repeating UWorld questions makes it harder to answer items you’ve never seen before.

Question #7: Amboss vs. Kaplan vs. UWorld?

tl;dr: UWorld is better at mimicking NBME-style questions. Amboss is better for delving more deeply into related topics.

As mentioned before, UWorld is still the best at mimicking NBME-style questions. That said, it is just a QBank. Amboss, in particular, has a more extensive “knowledge library” that you can use to cross-reference and learn things in greater depth. Personally, I still recommend UWorld and using First Aid and other resources to learn the topics in greater depth.

Question #8: Should I Wait to Do UWorld Until Right Before My Exam?

tl;dr: I recommend UWorld as the final QBank before your test to practice applying concepts to novel questions. However, since many more questions exist, you may not have to delay starting.

Should you save UWorld for last? Again, like much of the dogma, the answer will depend on what you believe the test to be. To you, are the USMLEs a test of knowledge? If so, then doing UWorld right before your exam may or may not be as important. What if you think the USMLEs test your ability to apply knowledge to questions you’ve never seen before? You will likely want to use UWorld as the final question bank before you take your test. (See above; UWorld is the best QBank I’ve found that mimics the real test conditions). If it isn’t already abundantly clear, I fall in the latter camp. QBanks are a learning tool, not a repository of facts. Use them to learn critical information as well as how to apply it to novel situations.

Concluding Thoughts

I wrote the first version of this article nearly ten years ago! In that time, there have been many changes, including:

  • UWorld nearly doubling the number of questions,
  • Many credible alternatives arriving (e.g., Amboss),
  • Step 1 moving to pass-fail, and
  • Much more

What I find surprising is that the advice students still give each other is almost identical to when I entered medical school in 2009. “Just do UWorld!” “I did multiple passes of UWorld – you should too!” Ultimately, your preparations and use of these resources will depend on your fundamental beliefs about the USMLEs. As a medical student and USMLE tutor, I worked under the assumption that Step 1 wouldn’t be a receptacle for me to regurgitate UWorld/First Aid knowledge. Rather I saw the exams as a series of carefully constructed questions that would test my ability to integrate and apply pathophysiologic principles. And since the NBME writes questions to test your ability to apply concepts, it’s unsurprising that those students tend to do better.

What do you think?  Are you still planning to repeat UWorld twice?  Other thoughts?  Let us know in the comments!

Photos by Jasper van der Meij, NeONBRAND

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.