How I Used UWorld During My Didactic Years

As a current pediatric resident and USMLE tutor, it is crucial for me to have a solid fund of knowledge that I can draw on to frame my medical decision making and to inform discussions with patients, families, medical students, consultants, and the other members of the medical team. While
there is certainly no substitute for clinical experience in gaining competence and confidence in clinical medicine, I give enormous credit to UWorld in helping me to build a solid mental framework on which I could superimpose my learning in the clinical setting and deepen my understanding of
the pathologies I encountered.

Indeed, like many medical students, I found myself a year and a half into medical school, at the end of my pre-clinical curriculum, at something of a loss: I had memorized a slew of facts every two weeks for each of our exams, yet had somehow failed to consolidate that knowledge into a coherent mental model for understanding disease pathophysiology and presentation. My medical school has a model where students do their major clinical rotations prior to taking Step 1 of the USLME. Given this, as I entered my clerkship year, I was quite interested in finding a resource that would help me review knowledge from all the disciplines I’d encountered as a pre-clinical student as I moved to seeing patients on the wards. I received consistent advice from older students that the single most useful resource in both (1) learning the fundamentals of clinical medicine and (2) preparing for end-of-clerkship shelf exams was the UWorld question bank for Step 2 CK. While I was on a medical student budget and initially balked at the price tag for a year-long subscription, I purchased the QBank. Within moments of opening the QBank, I recognized why the hype was
justified: a beautiful interface, thoughtful questions, detailed answer explanations, and thousands of questions for reinforcing core medical concepts.

In reflecting now years later why I found it so useful, I recognize that there are a few key features that make UWorld such an essential resource not merely for exam prep but for building a core medical knowledge base. First, UWorld is a learning tool, not merely an assessment tool – it’s more of an interactive textbook than it is a prolonged exam. Second, using UWorld consistently is in keeping with core principles of adult learning theory, chiefly those of forced recall, spaced repetition, priming, and interleaved practice. Third, UWorld expertly balances “breadth” with “depth” to create a well-rounded learning experience in a way that helps standardize the learning experience regardless of the idiosyncratic emphases of a given medical school.

UWorld as a Clinical Learning Tool

During my work as a USMLE tutor, I often hear students say that they have been waiting until their dedicated study period to use UWorld because they don’t want to waste the QBank by using it too early. However, based on my experience, both working with students and my own USMLE exams and medical school clinical rotations (all with scores >270 and with honors), I feel this is a misguided perspective.

UWorld can be used year-round. For especially high-yield topics (eg, hemodynamics in shock), UWorld has created excellent tables and illustrations that help distill the most important take-home points into easily digestible formats for rapid review, with additional details in the text for those seeking a more detailed understanding.

In addition, for diagnoses with clinical overlap and that are often confused with one another (eg, tension pneumothorax vs. cardiac tamponade, ulcerative colitis vs. Crohn disease), UWorld does a masterful job of presenting similar vignettes with just a few key differences between them, to help students identify the distinguishing features among the diagnoses. Students thus become less prone to cognitive biases like anchoring and recency bias. For example, not every child with recurrent respiratory infections has cystic fibrosis; instead, the patient may have chronic granulomatous disease, X-linked agammaglobulinemia, or primary ciliary dyskinesia. In presenting similar vignettes with subtle but key differences, UWorld increases the salience of relevant clinical information and helps students learn the fundamentals of clinical reasoning.

Using UWorld alongside my clinical rotations, I was struck by how often I had done a practice question on a particular topic and found its clinical application relevant within days. For example, I was quizzed in UWorld on the difference between bullous pemphigoid and pemphigus vulgaris; shortly after that, I admitted a patient with pemphigus vulgaris and knew to look for Nikolsky’s sign. Similarly, I had a UWorld question on the differential for new-onset thrombocytopenia; then, on rounds the next day, I correctly suggested testing for HIV and HCV in a patient with a new petechial rash. I did a UWorld question featuring a patient with fever and jaundice, then correctly identified Charcot’s triad of fever, RUQ pain, and jaundice in a patient admitted for acute cholangitis. Indeed, as I used UWorld throughout my clerkship years, my only regret was that I had not used the Step 1 QBank to supplement my pre-clinical studies so that I could have reaped the benefits of UWorld sooner.

UWorld and Adult Learning Theory

I alluded to these above, but it’s instructive to think about exactly what makes UWorld such an effective learning tool. Above, I noted how I felt primed by my studies with UWorld to pay more attention to salient features of patient care, and allowed me to be a more engaged learner. What’s more, we know that forced recall, or retrieval practice, is crucial for consolidating learning. That is, only by testing ourselves regarding a given piece of information do we move from passively studying material to truly learning it in a durable fashion. Like any QBank or flashcard app, then, UWorld builds in retrieval practice by making the mechanism of learning active rather than passive.

Beyond that, we know that spaced repetition, or being tested on the same concept at spaced and (ideally) progressively prolonging periods over time, is key to promoting long-term retention of facts learned. In having such a large QBank with many questions testing variations on similar themes, UWorld builds in spaced repetition over the days, weeks, and months that students use it to study. This is moreover a strong argument for the utility of starting the QBank prior to your dedicated study period: concepts that you learned once, then forgot, then re-learned again during your dedicated period are much more likely to “stick” on test day, and, of course, in future clinical practice.

And finally, UWorld does a masterful job of incorporating what’s known as interleaved practice – that is, integrating knowledge from one field with that from another so that connections among various subtopics become apparent and allow for learners to construct a more thorough knowledge base. Questions on drug side effects require an understanding of disease pathology, and questions on appropriate treatment require an understanding of the relevant anatomy. By including many such “two-step” questions, UWorld helps put knowledge into its appropriate clinical context, and in so doing allows details to sort themselves within a broader, well-integrated framework of knowledge, rather than promoting rote memorization. While other QBanks I’ve used employ similar strategies to a degree, I have yet to encounter a question bank that has mastered the above principle as seamlessly as UWorld has.

UWorld: Breadth and Depth

One of the chief difficulties for the students I tutor is identifying what information is relevant from the sea of available medical knowledge. In my experience, preclinical lectures were generally delivered by content experts who gave accurate but very detailed lectures; as a first-time learner, it was not always clear to me what information was most critical to learn (eg, what would be tested) and what information was simply for our edification (eg, the current state of research on a topic). Given that UWorld was the primary educational resource I used throughout my clerkship years and while studying for USMLE Steps 1, 2, and 3, I can confidently state that my understanding of what was essential markedly improved after reviewing the material in UWorld. If UWorld tested a fact or concept, then I needed to know it.

I also found that topics I’d long found confusing (eg, nephrotic vs. nephritic syndrome, metabolic disorders, immunodeficiencies) are organized and reinforced in a way that helped restructure my thinking on the topic. UWorld presents material at a readily understandable level to a newer learner without diluting the quality or quantity of the content presented, making UWorld an invaluable tool for getting a handle on the vast amounts of material necessary for success in medicine.

My Conclusion

To put it simply, UWorld is a masterfully crafted educational resource that can and should be used from the beginning of one’s medical education, not merely during dedicated USMLE test prep periods. I highly recommend early and frequent incorporation of UWorld into any medical student study plan.

Give yourself the best chance to succeed on the USMLE exams when you prepare with UWorld’s suite of USMLE learning tools.

[Originally guest posted on the UWorld Blog]