Getting The Most Out of Your USMLE Q-bank

Nearly everyone prepping for a USMLE will use one or more question banks. However, some approaches to Q-banks work better than others. This article will explore the principles that underlie successful outcomes of using Q-banks. Successful outcomes refer to measurable increases in mastery, retention, and test-taking skills. While there may be slight variations in how these ideas apply to different people, most of them will be the same for most candidates. Here are five ways to ensure you get the most out of your Q-bank.

1. Review concepts before you see them in a Q-bank.

I universally recommend a staggered approach to practice questions for the first (or only) Q-bank used during USMLE prep. This means that one “chapter” of material has to be completed, and then practice questions from that chapter would be done while studying the next chapter. This requires an organ, discipline, or systems-based approach to content rather than a mixed/random approach. Candidates should only do mixed blocks of questions after a solid foundation of knowledge has been built, which just needs finetuning in the final weeks before the exam. In earlier periods, a systematic and structured review is necessary to optimize mastery of the material.

The staggered approach’s primary goals are increased review efficiency, better consolidation, and improved retention. If, for instance, you have reviewed the coagulation cascade before being tested on it, you can review the explanation of the question significantly quicker. This is because you would be refining your mastery of the concept instead of learning it from the question. Another benefit of the staggered approach is that it adds a layer of spaced repetition. Effective spaced repetition is indispensable for long-term retention. Principles of mastery and retention are discussed in another article.

2. Prioritize quality of review over quantity

As one of the four pillars of USMLE prep, mastery is of the utmost importance while using Q-banks. It is far more beneficial to solve ten questions in one day and have a good mastery of the concepts than to solve 40 questions and have questionable mastery. Unfortunately, candidates for the USMLE often go straight for speed. They then attempt to solve the problem of mastery as an afterthought, usually by the brute force of repetition. This approach has lukewarm results at best and outright fails a lot of the time. Instead of this, I encourage my students to prioritize mastery, even though that slows them down at first. For candidates with the discipline to do so, speed naturally increases as they progress. This is logical because the more mastery you have, the easier it is to master more related concepts. The total prep time is similar, but outcomes are better when mastery is a priority.

I paid close attention to the foundation of knowledge I built during my clinical rotations, which led to a relatively high baseline self-assessment score at the start of my dedicated CK prep. I set a goal of 40 questions per day, which I managed to meet by day 1. I was up to 160 questions per day by the end of my 6-week prep. Duration of prep for anyone is, of course, determined by the distance between baseline and target scores and the speed at which they can prep. This example shows that the number of questions I could review and master in one day was four times higher by the end of my prep than at the beginning. What remained constant was my attention to how well I was mastering concepts. Whether the first day has 5, 10, 20, or 40 questions, speed will increase significantly over time if mastery is sufficiently prioritized.

3. Have a plan for consistency

Optimizing outcomes of using Q-banks requires a predetermined plan. As with any medium to long-term goal, it is essential to determine an endpoint and determine what needs to be accomplished per day, week, and month. Regarding Q-banks and USMLE prep, discipline and routine are your best friends. It helps to set aside a block of time each day for questions. Ideally, it would be the same time each day, and you would do the same number of questions each time. I recommend that my students do their questions (in timed mode) as the first study activity each day. An example of a plan would be “twenty questions in 30 minutes and 2 hours to review the answers. After factoring in three 10-minute breaks per hour, that gives a total of 3 hours for questions to be done from 8:00 am to 11:00 am Monday-Friday”. Track your performance relative to your goals and adjust accordingly (for example, by increasing the number of questions to 25 if you’re comfortable at 20, taking steps to eliminate distractions if necessary, or increasing the amount of total time if you’re at optimal efficiency and still don’t finish on time)

Please don’t solve questions on a bus, train, or in other “I-need-to-kill-time” settings. It is challenging to ensure high-quality mastery while reviewing such questions unless you have a ton of discipline. It isn’t worth attempting except in certain exceptional cases.

4. Analyze error trends and respond accordingly

The USMLE and other exams like it are unique in that your test-taking skills are almost as crucial to success as your actual competency in the subject matter. Despite this, I have noticed that USMLE candidates often devote ample time and resources to subject matter competency but make few efforts to boost their ability to answer USMLE-style questions. While multiple factors can be optimized to enhance test-taking ability, the most significant way to do so is by carefully analyzing incorrectly answered questions.

There are four significant reasons for failed questions and a few minor ones. The first is “new concept,” which implies that the candidate has never encountered a tested concept during the prep period. The second is “mastery,” which means that the concept has been studied but not correctly or fully mastered. The third is “retention,” which implies that the concept has been encountered and mastered but subsequently forgotten. The fourth is “misdiagnosis/misinterpretation,” which means that the concept has been encountered, mastered, and retained such that although the candidate has all the knowledge needed to answer the question correctly, they somehow bungle the approach to the question. Finally, less common but still possible reasons are “flawed question,” “time management,” and “accidental choice/carelessness.”

I guide my students in keeping track of the reason for every question that is failed during practice tests and analyzing the trends over time. This is because each of those problems has a very different solution. Consequently, the insight that this analysis provides into the unique test-taking issues faced by any given candidate is invaluable in targeting interventions. Suppose, for instance, a candidate has a mastery problem due to a low-quality approach to reviewing the material. In that case, interventions like repetition that target retention more than mastery will likely be ineffective. Similarly, if a candidate achieves good mastery but has a retention problem, interventions that target mastery are unlikely to be productive.

5. Avoid repeating a Q-bank

It’s common to hear candidates for the USMLE talking about first, second, and even third passes through uWorld. While psychologically comforting, Repeating a question bank is less helpful to eventual performance than simply doing a brand new Q-bank. It is already well established that the number of unique questions a candidate sees is directly related to their success on test day. This next part is more anecdotal but still logical; question blocks done during a second or third pass will significantly inflate the perceived mastery of a candidate relative to their actual mastery. Many questions will be correctly answered based on the memory of the correct choice, as opposed to thinking critically through the question. Even worse, there would be a higher tendency to skim/rush the explanations instead of ensuring high-quality mastery. Again, this would be because of the perceived high mastery and an “I’ve seen this before” mentality in the background.

Instead of planning to do a Q-bank twice or thrice, it would be better to use one Q-bank in the earlier stages of prep and use the second one (usually uWorld) in the final months/weeks before the exam. For the same reasons as above, it is highly discouraged to reuse self-assessments. Inflated performance is a likely factor when candidates have high performance metrics before exams, only to perform significantly worse, or even fail outright, on test day.

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