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How to Prepare for USMLE and COMLEX During a Pandemic

We selected ten common questions that medical students have asked us about preparing for USMLE and COMLEX board exams during a pandemic, and provided answers to guide their study habits.

How do I memorize all the material I need to know for the USMLE and COMLEX?

Spaced repetition is key! It is easier to learn and to memorize material when you have seen it multiple times over a period of time. It is important that you develop a system in which you are reviewing notes, content, and key facts regularly throughout your study period. Different things work for different students, but you can consider blocking out 1-2 hours per day to review old notes or flashcards. When it comes to flashcards, I am an Anki fan! Anki is a program that allows you to create flashcards and efficiently review all your materials. This is key to ensuring that you don’t forget about the material that you haven’t recently seen.

What advice do you have for international medical students taking the USMLE and COMLEX?

Board exams are a wonderful opportunity to shine and demonstrate your ability to perform at a high level. Many IMGs who are successful on these board exams become competitive for US residency spots. I encourage IMGs to block out a long period of dedicated study time (3+ months) in order to ensure that they have an adequate amount of time to master all of the materials. 

It is very important to avoid rushing into these exams. If your practice exam scores aren’t where you want them to be then consider delaying your exam and studying for longer. If you are up against a wall or feeling like you have plateaued, then consider getting professional USMLE/COMLEX tutoring.

In what order should I take the step exams?

There is a surprising amount of overlap between Step 1 and Step 2 CK. Although there is no formal rule for what order you take these exams, your school usually has a policy for when you should have your exams completed. You typically have to stick with your school’s policy, so you don’t have too many options here. However, even if given the option I think that it makes sense to take them in the traditional order: Step 1, Step 2 CK, Step 2 CS and then Step 3. 

If able, try to take Step 2 CK soon after Step 1 (1-2 months afterward if you’re studying full time) as there is a lot of overlap, and studying for Step 1 can help prepare you for Step 2 CK. 

If you are taking a gap year to do research, an extra degree, global health, etc. then I strongly recommend taking Step 2 CK at the end of the third year before you leave for the year. Otherwise, you will be taking the exam 1-2 years after your clinical rotations/shelf exams and none of that material will be fresh in your brain.

How will COVID-19 affect medical school board exam scores this year?

No one knows the answer to this question; however, I suspect that scores will not be too different than previous years. It is possible that there is less of a score “creep” than is typical on a year over year basis. However, don’t expect program directors to view your score any differently than previous years.

What to do when you are unable to effectively study for exams while stuck at home?

Although this has always been a relevant question, it is even more relevant now given the pandemic and the numerous changes in work from home culture. It is important to identify a space where you can effectively study. Ideally, this would be at home but can also be elsewhere. Some schools are allowing their students to continue to utilize their learning spaces for independent studying and some libraries remain open. If you are really struggling to find a place to study, then it may make sense to rent a room/apartment for 1-2 months so that you can focus on preparing for your exam. These exam scores are permanent, and you want to ensure that you are in the best position that you can be to excel.

What is the best way to balance second-year coursework with board studying?

Time management! The key to balancing multiple responsibilities, in this example second-year coursework and board exam studying, is to manage your time efficiently and effectively. This is a great skill to learn early and will continue to benefit you as a third-year medical student studying for shelf exams or as a resident preparing for your in-training exam (yes, you’re correct, the tests never end!). 

Create a schedule for yourself and stick to it! If there are seven days in the week then it is reasonable to schedule one day off, three days to focus on your coursework, and then three days to study for your board exam. You can create a daily schedule for yourself as well to help keep yourself focused, accountable, and ensure that you are able to cover an adequate amount of information per day. 

Identify times during the day where you are most productive and try to cover the most challenging content during that time. Schedule less-demanding activities (flashcards, doing questions on your phone, podcasts, videos, etc) for bus/shuttle/subway rides, waiting for your next class to start, late at night when you’re tired, etc. If you haven’t gotten used to streaming lectures at 2x speed, then now may be a great time to start! It is very important to learn your second-year coursework but most of your exams will be pass/fail and you don’t need to get every single detail correct. This is the time to start focusing on Step 1.

How many blocks a day should I do and what is the best way to use a question bank when reviewing for board exams?

It is reasonable to aim to complete and review 2-3 blocks of 40 questions per day. Each block takes approximately 1 hour to complete and should take 2-3 hours to review. If you are spending less than 2 hours reviewing a block, then you are probably moving too quickly and if you are spending >3-4 hours then you’ll need to move quicker in order to make it through everything. Question banks should be utilized as a tool to practice your approach to multiple-choice questions and as a learning resource. 

When reviewing questions, you want to ensure that you are getting the most out of your review. Try covering up the answer choices with a piece of paper and re-reviewing the entire question stem. Look for keywords and buzz phrases and try to understand what is going on with the patient and what path the question writer is trying to take you down. Try to name what is going on (i.e. heart failure, myocardial infarction, XX drug mechanism) and then guess what the answer is before you uncover the answer choices. After you uncover the answers choices be sure to not only review the correct answer but also the incorrect answers. You can learn a lot from understanding why the wrong answers are wrong. 

Spend some quality time reviewing the question explanations and take notes when necessary. Review the explanations, diagrams, and tables. Some of these materials are better than most textbooks!

How many questions should I plan to complete prior to taking the USMLE and COMLEX?

You should finish one entire question bank, at a minimum, which is approximately 2,500 questions. It would be ideal to complete two question banks for a total of >5,000 questions. However, the quality of your review is infinitely more important than simply the number of questions that you have completed. Don’t rush through a ton of questions just to get them done.

What is the number 1 thing to do when preparing for Step 3?

Complete an entire question bank focused on Step 3 content and practice the computer-based case simulations (CCS). The hardest part of the CCS scenarios is how different and unknown the platform is. It is important to familiarize yourself with the structure of these scenarios and what you need to do in order to score points. Create a systematic approach to these cases and practice your approach so that it becomes second nature. Even if you don’t understand what is going on in the clinical scenario you can still do several tasks to help score some points.

What study strategies help maintain momentum and consistency after weeks of studying for board exams?

Like any other task that requires dedication and determination, it is important that you create a goal and stay driven, engaged, and focused on that goal. Imagine yourself succeeding and what this would mean for you. Focus on what this success may get you (i.e. specialty, geography, program, etc.). Celebrate the little wins and try not to get too frustrated when you forget things or don’t score as high as you would like to on your practice exams or question bank blocks. Stay positive and persevere.

It is important to maintain your physical, emotional, and mental health during this time. Schedule time off to relax. Continue doing the things that bring you joy. Schedule time to spend with friends and family, even if these are just phone or Zoom calls. Eat well, sleep a little, and continue to exercise. Consider doing yoga or meditating. If you have a pre-existing health condition then make sure that you stay connected with your medical provider, continue your medications/therapy, and take care of yourself.

Joel Ramirez MD

Dr. Ramirez attended University of California, San Francisco where he is a vascular surgery resident. He received a 266 on Step 1 and 265 on Step 2 CK. He oversees the team of elite USMLE and COMLEX tutors.

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