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When to Start UWorld for USMLE Step 1

Birds eye view of someone using laptop for USMLE Step 1


UWorld is unquestionably the best resource for the USMLE. Students have been known to score 270+ on USMLE Step 1 just by using UWorld and First Aid. There are also students, however, who have gone through the question bank 3 or more times, and can’t seem to get a passing score on the exam. This underscores the fact that UWorld is effective only if used properly. How and when to start using UWorld are often a matter of debate. Through our experience with high-scoring students, we have determined the most effective ways to get through this high-yield resource. 


UWorld should be started during the first year of medical school.

You should begin using UWorld as a supplemental learning tool in preparation for the basic science exams during your first year of medical school. UWorld is a great resource for the pre-clinical years of medical school because it allows you to focus your studies on material that will be tested on the USMLE. Furthermore, it can help students ace their pre-clinical exams as the breadth and depth of knowledge tested are often on-par with what is expected from each individual medical school. The ability to select individual question topics is key to this approach. If your school starts off with biochemistry, prepare for the topical exam using the UWorld biochemistry questions prior to your exam. A great strategy that some students find helpful is to start a limited number of UWorld questions at the very beginning of the topic covered – prior to actually getting through all the material required – because it can help narrow the focus of their studies as they go through the material. Then, some students will do a second pass of the topical questions prior to their topical school exam, and get through 2 or 3 blocks of 40Q in the days leading up to their pre-clinical exam.


Some students become frustrated with UWorld because they find that they haven’t learned all the material that is tested in the question. This frustration leads students to push off taking questions until later in their studies, because they assume that they will learn the material later. Do not make this mistake! Medical school lectures, First Aid, and even very detailed video review platforms like Boards and Beyond will not cover all the material that is presented and tested in UWorld. UWorld is not just a reinforcement platform – it is also a learning platform. When students get a question wrong in UWorld because they didn’t know all the information, students should use the opportunity to learn the material. They should annotate their First Aid, go through the relevant lecture material, and solidify any facts using self-made flashcards. The sooner students begin this process, the better. If students start UWorld during the first year of medical school, the habit of review and annotation will be painless and efficient by the time students start feeling the time crunch during their dedicated period of study.


A second pass of UWorld should begin no later than the start of the dedicated study period.

Going through the question bank a second (or third) time reinforces all the material students should have already learned at some point during their medical education. During the initial periods of dedicated study, students should be taking blocks of at least 20 questions, with at least 50 questions covered per day. Most students will do a block of 40 topic-specific questions focused on whatever topic they are reviewing at the time, and then a block of at least 10 mixed questions. These mixed questions are extremely important – getting through mixed questions helps reinforce, recall, and mimics real test day conditions where the topic will not be pre-selected.


If a student hasn’t had the opportunity to start UWorld during their first year of medical school and are just beginning the resource during their dedicated period of study, the approach remains the same. Ideally, students will still complete 2 passes of UWorld prior to taking the exam. If the period of dedicated review is 2 months or more, this is often feasible with advanced planning. There are currently 3000+ UWorld questions and growing. If a student has 60 days of dedicated studying, the student would need to get through 2 blocks of 50 questions per day to get through 2 passes of UWorld. This is doable! Granted, getting through this number of questions will be challenging and time-consuming, so students in this position should limit their resource use to UWorld with First Aid annotation, and use a condensed video review platform like Osmosis when necessary. If a student has not had a chance to start UWorld prior to their dedicated study period which is 6 weeks or less, this is the rare case where it is advisable to focus on getting through UWorld just once. Students should plan to get through 1 to 2 blocks of 40 questions per day, and if time remains, then getting through the incorrect questions closer to exam day can be helpful (rather than doing a full UWorld reset). 


In summary, the sooner you start UWorld, the better!

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About the Author

Karolina Woroniecka, MD/PhD

As a former Howard Hughes Medical Institute Student Fellow, Karolina Woroniecka graduated Phi Beta Kappa from Brown University with a B.S. in Biology and Hispanic…

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