7 USMLE Step 1 Practice Question Mistakes to Avoid

At Elite Medical Prep, the vast majority of our students use UWorld as their primary USMLE Step 1 practice question bank. Over the last 9+ years that we’ve been in business, UWorld has become widely recognized as the gold standard qbank for all steps of the USMLE (as well as the MCAT). Students who use UWorld achieve consistently excellent results– but, where can they go wrong? We polled our Elite team of high-scoring tutors to come up with a complete list of mistakes to avoid while reviewing your USMLE Step 1 practice questions. Here is what they said:

1. Not starting UWorld early enough

Many students come to us concerned about starting questions too early. They worry if they start UWorld too early that, when they start studying “for real,” they will remember the questions and select answer choices based on memory. This is a mistake! Step 1 is a question-based exam. Therefore, the best approach to prepare for it is to incorporate USMLE Step 1 practice questions early and often. One effective approach is go through the questions once during the first two years of medical school, with a plan to reset the question bank during focused board exam studying (each subscription to UWorld >6 months comes with the option to reset all questions). Starting early makes sense because, even if you have not finished all of the material five months before your exam, there will be at least some content you’ve covered. For example, if you studied biochem as a 1st year, do some biochem questions. If you are currently in your heme block 2nd year, do some heme questions. Attempting difficult questions on a topic you’ve already covered is a great way to focus your studying and highlight areas of deficiency. At the same time, don’t shy away from mixed sets or disregard questions you get wrong that you haven’t yet covered the topic for, thinking “oh I’ll get that right once I’ve done cardio, etc.” Don’t be afraid to get things wrong! Finally, there are so many questions in UWorld that, by the time you get to your intensive study period, you will have likely forgotten many of the questions, and “remembering” questions won’t be an issue, as long as it is at least a few months between rounds of UWorld.

2. Not spending enough time reading USMLE Step 1 practice question explanations

This is one of the biggest mistakes Step 1 students make when working through USMLE Step 1 practice questions. 240+ scorers know that the true value of UWorld lies in the high-quality explanations. The questions are vehicles for practicing the pattern-recognition, clinical reasoning, and test-taking skills needed to score high on the USMLE. However, just doing questions and skimming explanations is not enough to achieve mastery of the material. Top scorers understand that UWorld is best used as a learning tool, and most of the learning happens when reviewing explanations to incorrect answers but also to correct answers. Even the most straightforward UWorld questions have a lot of knowledge you can pull from them. For the ones you know immediately, challenge yourself to explain why each wrong answer is wrong. This moves the review process away from simple pattern recognition to critical evaluation and active recall of concepts. We recommend that students (on a 1st pass through qbank) spend 2-3X as long reviewing explanations as completing the questions. This includes time spent looking up content in high-yield resources, cross-referencing the material in First Aid, making flashcards, and reviewing the linked qbank material, including images and tables. Don’t skimp on question review! When it comes to UWorld, prioritize quality over quantity.

3. Not linking explanation review to First Aid

We all know that First Aid is the key book to use for Step 1 prep. What many students do not realize is how to effectively integrate First Aid study with their USMLE Step 1 practice question review. Anyone who has opened up First Aid to a random chapter and tried to read it recognizes the difficulty of getting through the book as a standalone resource. What we’ve found from our own study experiences, and through our extensive work with students, is that linking UWorld to First Aid is an effective way to make the book content stick. Many students also find it helpful to have an electronic searchable copy of First Aid to expedite the process of connecting material in UWorld to First Aid.

4. Prioritizing percentage correct over learning

We all love numbers, percentages, trends, etc. However, many students become too concerned with percent correct and cumulative results, looking at qbank performance to validate their knowledge when what really matters is how much they are learning from the explanations. We cannot stress this point enough: UWorld is primarily a LEARNING tool, NOT an assessment tool. Additionally, students who focus too much on numbers are more likely to become afraid to take the next block unless they’re confident their score will improve, when in reality working through USMLE Step 1 practice questions and learning from the explanations is one of the best ways to achieve the understanding needed to improve! Sometimes students spend way too much time obsessing over small and/or unfamiliar details in some of the UWorld explanations such that this impedes their completion of the QBank in an efficient manner, and they miss the main point(s) of the question being asked. Furthermore, it is nearly impossible to correlate UWorld percentages with board exam scores, and “average” percentages displayed by UWorld can be misleading, as students use the question bank at varying points in their studying. Therefore, UWorld scores should NOT be used as a predictor for board exam scores. Keep the focus on where it should be: learning the exam content and improving test-taking skills.

5. Not making it through your USMLE Step 1 practice question bank at least one full time

This is a trap that students fall into for any of the following reasons: waiting too late to start, focusing too heavily on percentages, not wanting to waste the questions, wanting to start with an easier qbank as a “warm up,” skimping on question review. What students often do not realize until too late is that there is an overwhelming amount of content in UWorld found primarily in the explanations, and it can take multiple passes through the qbank to really learn this content. Most students do not have photographic memories, which means that repetition is the key to mastering the material. If students are short on time, they should at least go through their wrong or marked questions more than once.

Caveat: Many US medical schools have started suggesting that students take Step 1 well into their clinical curriculum in order to first get experience on the wards and with shelf exams. The data show this works: students who wait to take Step 1 until they complete some clinical work perform better on Step 1 than students who take the test after completing second year. For students who take Step 1 with some clinical experience under their belts, UWorld x1 may be sufficient. 

6. Not referencing UWorld when reviewing practice NBME exams

Many students do not go back and search through their USMLE Step 1 practice questions for hard topics they’ve missed. When students come up against an NBME question that they find tough, or don’t quite understand, they should try to search for a similar question in UWorld. The UWorld search tool is a great function to use in tandem with NBME explanations. On a similar note, taking the time to learn how to navigate UWorld and use all of its functions is important – many students don’t know every question has an ID, how to use the search function, how to mark questions, how to analyze time spent on each question, etc.

7. Not utilizing timed, random mode in the last month of studying

Some of the best exam-day preparation involves simulation. This means doing timed, full-length, mixed, random sets. If 40 cardio questions are done in tutor mode, the subject is fresh in your mind and compartmentalized during that session. Unfortunately, the test is not like this and will require you to switch quickly from subject to subject. Getting used to time constraints while dealing with multiple subjects per section is an important skill to develop for test day. The discipline to pick an answer choice and stick to it, versus skipping the question with the intent to return to it later, is also important. This is impossible to simulate in tutor mode.