Question Banks for USMLE Board Preparation: How to Use Them

[Editors Note: This blog posting was updated on March 16, 2016 with respect to the number of questions per block on the USMLE Step 1 exam.]
You have probably heard by now that you must incorporate a question bank into your board preparation. There are several commercial question banks available with the two most popular being USMLE World and Kaplan Qbank. Both have great reputations and each has their own strengths. When we receive feedback from students, it will differ as to which question bank has the most questions that focuses on esoteric facts and which is more conceptual and higher application. However, I believe that the vast majority of students would concur that USMLE World is “harder." Whether you choose USMLE World or Kaplan or both – it is important that you complete the question bank.

The students who do not pass the Step 1 exam have made the following errors with the question banks:

When you begin your question bank and know how and why you are using it, you will benefit from it the most. After years of working with students preparing for course examinations and USMLE, several distinguishing features have surfaced as key elements of using self-assessment as a key tool in preparation for the USMLE.

Reasons for Using and Doing All Questions in QBanks:

A. As you go through the question bank test items you will learn several things about your testing skills, the test itself, and how to adapt your behaviors to be better test taker. After practicing on 2,000 test questions the actual exam will not overwhelm you.

B. You will become intimately familiar with the FRED software that the USMLE uses so your marking methods will be maximally efficient and useful to your success.

C. If you follow the guidelines outlined in this article, your time management on the exam will be exact and you will know how to manage catching up on a block if need be.

D. You will learn your areas of strengths and weaknesses as well as how and when to guess on items.

E. You will figure out when to change your answer and not to change your answer.

F. You will learn additional content that is not covered in the books you are using for review and you will learn how to integrate concepts and apply them in ways you have not yet done in your courses.

G. You will learn how to get “in the head” of the question writer to figure out, "What do they want me to do with the pieces of information I have learned?", but better yet..."How do I learn my review material for better application and integration?"


How to Use the Question Bank

Always use your question bank in mixed mode. Do not use your question bank in tutor mode or by subject. If you do, you will be wasting questions that you will need later for assessing your knowledge and performance level. Always use your question bank in mixed mode so you are used to switching topics quickly and there will be no hints as to what the answer will be if you do the questions by subject. Always set yourself tests of 43-50 questions so by the time you take your actual USMLE you have taken so many simulated exams that you are like an athlete ready and trained for a marathon. The real exam will be a challenge, but you will be confident that you are prepared and know how to manage all the obstacles that might arise. (If you use a question bank to prepare for course exams and sort questions by subject, then use the other commercial question bank to prepare for USMLE)

After you get half way through your Qbank, always do timed tests. You are training for one of the biggest events of your medical career. It is quite a marathon in terms of brain energy and physical stamina and you have to prepare your body and mind for the arduous challenge. To do so, you must do as many of your question bank questions and timed tests as possible.  It is essential that you know how to quickly read and assess each question since you will have about 60 seconds per question before you need to move to the next one. (The number of questions per block on a given Step 1 examination form will vary, but will not exceed 40. You many take short breaks between blocks, but most advisors and students recommend one short (timed) break for a pre-packed lunch that lasts 30 minutes.)

Analyze your timed tests to see what you are doing right and wrong. When taking the practice questions as timed tests, it is good to go back over several afterward and analyze not only your errors but also what you did right. You approach your testing experience like you would when analyzing patient results or research results – scientifically. When you go back and analyze a timed test, take a close look at test items about which you were unsure. If you changed your answer on those test items, count the number of time you changed your answer to the correct answer verses to the incorrect answer. After you do this for several practice tests, you will be able to figure out what is best for you – to stick with your original guess or go back and change it after you reread the question and think about it again.

Average your last 10 sets of 46-50 questions to know how you are performing. Know that when you begin the question bank that you will do poorly. This is normal. You have not yet laid a proper foundation of information or figured out how to integrate the information you have learned in your classes or clerkships. Many students become discouraged because of this, but please don’t. It is part of the normal growth process in your preparation. After you get halfway through your question bank, you will begin to see your scores improve (if you have been reviewing the explanations to the answers). To know how you are progressing, average your last 10 timed tests rather than your average from the beginning of the question bank. You may still have a bad test once in a while. This happens to most students. When this happens, just analyze the test to figure out why you did poorly and move on.

Become intimately familiar with the computer software for the exam. Use the highlighting, underlining, and marking software during practice sessions to see if it is a feature that you want to use during your actual exam. In order for you to use the FRED software features to your advantage, you must use it during practice sessions. It may keep you focused to use the highlighting or underlining features, but it may also slow you down to the point that you are not completing blocks. If you rely on the software to concentrate and not miss essential information, you must be proficient with the features so that it is second nature and you can easily navigate its use to your advantage. You can also decide not to use it on short easy questions and reserve its use to longer, more difficult questions or questions on topics that give you problems.

Get in the head of the question writers. When you get a question wrong in your question bank, figure out why you got the question wrong. This should be done, not only from the perspective of “what information was I missing?”, but also from the angle of “how was I thinking about this question differently than the author of the question?” or “what was I supposed to do with the basic science facts that I did not do?” or “how was my reasoning off?” Your job is to figure out how the question writers want you to think about the information and how they want you to integrate and apply concepts. If you make this attempt, and you figure it out, even for certain topics only, then you are way ahead of the game. This is a primary reason why students’ scores begin to increase after they get past the halfway mark of their question bank. They have started to anticipate the reasoning behind the questions. Now, with their foundation knowledge, they have become better able to reason through the question to the appropriate answer.

After you have completed 2,000 practice questions and their explanations, take at least 2 NBME self-assessments to further familiarize yourself with board type questions and see if you are ready to sit for your USMLE.

For insights into how to take Step 1 questions try reading the article at:

Essentials to Reasoning through Step 1 Questions

It's important to have a strategy for what and when you will study. Many students find the structure of the Doctors In Training USMLE Step 1 Review Course, the Doctors In Training USMLE Step 2 Review Course and the Doctors In Training USMLE Step 3 Review Coursebeneficial to their exam preparations. Our courses presents the high yield information you need to know and are updated annually to reflect student feedback.

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