How I Studied for the COMLEX Level 1 and USMLE Step 1 Exams

My approach to studying for boards was slightly different from that of my classmates and probably what most people do. If you’ve been following my blog from the beginning, then you already know my bad history with standardized exams which includes taking the MCAT four times, and this scared me into starting extra early with my board preparation and maybe even going slightly overboard with it. For the record (and in my opinion), the MCAT has absolutely no bearing on how a student will perform in medical school or on their board exams, but I wasn’t about to take any chances. So with that being said, while most students start studying for boards 6 weeks to 3 months out, I started my studying 6 months from my exam date, and I have absolutely no regrets.

I had two major goals before I started studying for boards: I wanted to keep my resources to a minimum to avoid getting overwhelmed and I wanted to have done at least 8000 questions before my exam date. I met both of my goals and even exceeded the minimum number of questions I had planned.

Resources

For both exams, I used First Aid for the USMLE Step 1, Pathoma (both the book and videos), UWORLD, USMLERX QMAX, and Combank. I also took all six NBME exams along with the free NMBE exam, and I completed both UWORLD assessment exams. For my COMLEX exam studies, I added in the Saverese OMT book, but did not take any COMSAE or NBOME exams outside of the one that was administered by my school. I did every single question in each question bank listed, and for UWORLD, after my first pass was complete at the end of February I re-did all my incorrect and marked questions. When I was 6 weeks away from my exam, I reset UWORLD and completed the entire bank again on timed, random mode (I used tutor mode during my first pass). I also completed both the USMLE and COMLEX side of Combank, along with all of USMLERX and when all was said and done I believe this added up to having completed a little over 10,000 questions (not including the assessment exam questions). I also dabbled with the Doctors in Training videos, but I wasn’t a huge fan, and I did read the First Aid book completely through about twice. Additionally, I used Picmonic for any topics that I just couldn’t get drilled into my head, since it was a lifesaver for me during my first two years of medical school. If there was anything I would have done differently, it probably would have been getting in another pass of UWORLD because on my USMLE exam, there were multiple questions that were extremely similar and the exam also had the exact same format as UWORLD. I also would have probably read my First Aid book a few more times.

Maximizing the Question Banks

I know a lot of people tend to get caught up about their scores on the question banks, but I focused on using the question banks as strict learning tools. By this I mean I did not get upset with my super low UWORLD scores when I first started, but instead I used it as an opportunity to explore my weaknesses. Also, outside of my first pass of UWORLD I did all of the questions in each bank without assistance so that I could really see what I needed to work on. This meant lower percentages, but I tend to learn from things I get wrong, so more information stuck with me. What I found extremely helpful was reading over EVERY answer choice explanation on questions I got both wrong and right, and I annotated the information I did not know into my First Aid book.   

Schedule

Studying for boards was hard while classes were in session, so I think when I first started I would just do maybe 20-40 questions per night. I treated the upcoming exams as if I were preparing for a marathon, and eventually (towards the end of my exam preparation) I was doing over 200 questions a day. I waited until I was six weeks from my exams to create a dedicated board study schedule, and I previously gave a snippet of what my daily schedule was like HERE, so I won’t go into too much detail about it right now. Our school does not offer a set dedicated board study time without classes, but I was lucky enough to have tested out of the OMM written exams during my last term, so I only had to be on campus for about 3 hours each week during my final six weeks leading up to my exams. This allowed me to really be able to put in full days where I only studied for my board exams, and that was typically between 10 – 14 hours of study time each day. My days were starting at 430am and not ending until 8 or 9pm, so it was an extremely stressful time. I made sure to schedule in breaks so I didn’t go crazy and I also took one day every week where I did absolutely nothing exam related and just relaxed or spent time with my daughter.   

Summary

So basically, my approach to my board exams was questions, questions, and more questions! It is true that everyone studies differently, but doing questions will not only help you figure out what to expect on the exams, but it will help build your test-taking stamina as well. Most people swear by UWORLD, First Aid, and Pathoma and while I did slightly more than that, I’m pretty sure this would have been sufficient. I don’t think there would have been any way to pass either exam without UWORLD, so if you’re on the fence about buying it, just suck it up and get it! Also, if you’re an osteopathic student who only plans on taking the COMLEX, I would still suggest using UWORLD because it is that good.

In my next post I will compare and contrast the USMLE and COMLEX exams, so stay tuned for that, but hopefully this gave you all an idea of how to go about these exams. Feel free to email me if there is any confusion, but hopefully my next posts will clear any of that up. Just keep it simple, do questions, stay positive and everything else will fall into place :-) 

A Post for the Pre-Meds: Newly Accepted, but Afraid of Future Failure

@D Ward Something has been plaguing me. How did you adjust to your first year? I got accepted to WVSOM and I'm trying to think of good studying techniques before starting my first year. How do you know when you are ready? I'm just afraid of having a bad exam lol losing it. I just guess I'm just a little scared of the unknown lol

Sorry to go out of order from answering the questions I have received, but even though this one was asked more recently, I feel it’s a question that many newly accepted students are having at the moment. In my opinion, I don’t think any student entering medical school feels completely ready at the beginning. I mean, sure you might have advanced degrees, honored your way through college, and/or a whole bunch of other things that affirm your ability to handle what is to come, but like any new thing in life, you will still be entering into the unknown. You really won’t know you’re ready until you’re actually in the midst of everything, but you would not have been accepted if your school didn’t feel you were ready for the challenge. Now I am just a first year student myself and still adjusting, but I have felt the same anxiety with each new term, and probably will continue to with each new step.

As for being afraid of having a bad exam, I think it would be pretty hard to complete medical school without having had at least one bad exam. For some people, the word “bad” could mean not making an A on an exam, and for others it could mean failing an exam, so I think the word is pretty subjective. I think it is more important to stay positive and focus on the good, rather than the bad. It just doesn’t make sense to plant negativity in your mind and set yourself up for failure before you even start.

 For what it’s worth, I have already had the experience of having failed an exam, and even though I thought it was the end of the world at the time, I still ended up being fine. My second term of medical school was a great one for me, but it was a lot harder for me to adjust to my first term. My worst exam occurred a couple days after the white coat ceremony, and I performed so poorly on it that I was called into a meeting with the Student Progress Evaluation Committee (SPEC). At the time, I thought students were only called into a meeting with this committee if they were a part of the bottom ten percent of the class and in danger of being kicked out, so I completely freaked out. Apparently, this was not the case, but it still really stressed me out. When I walked in the door, the first thing one of the professors asked was “what the hell happened?,” and I was given the opportunity to explain why my performance was so low on that particular exam. At the end, I was basically told to go back to doing what previously worked for me, but I took away a few important points from the entire experience that I have shared below.

Don’t get bogged down with resources

I might be a bit biased, but I’m pretty sure my class beats out any medical school class out there. Not only am I surrounded by a bunch of wonderful, intelligent individuals, but everyone is always willing to help out each other in any way possible. Whether it’s sharing textbooks, websites, notes or anything else needed to succeed, there is always someone in the class willing to go out of their way to help the next person. With that being said, it is so easy to become overwhelmed with all the resources offered! It is so important to identify the best (and least amount) of resources possible that can help you achieve your goals. If you try to use every resource that you are offered, not only will it add more time to your studies, but it might burn you out even faster.    

  

Don’t focus on what (or how) other students are doing

This bounces off the last point, and I know I’ve said it before, but it is so important to do what works for you! You might have a classmate who only studies the PowerPoint slides the night before an exam, and somehow ends up acing everything, or another who spends at least twelve hours a day studying to do well. The reason why I failed the exam that I previously mentioned was because I started focusing on what everyone else was doing. I asked my classmates what worked for them, and then I tried to incorporate everything into my studying which turned into a disaster. Plus, if everyone around you seems to be doing well, and you aren’t, it can cause you to become slightly depressed which will negatively affect your grades.  

Study smarter, not harder

The first term of medical school I studied a minimum of five hours every day and tried to at least get in sixteen hours on the weekend. Looking back now, this was overkill. I was studying my notes, reading textbooks, doing practice problems, and using board review resources. If I had identified the best resources early on, then my studying time would have been cut in half. I also sacrificed a lot of sleep, which is always a no-no. It doesn’t matter how many hours of studying you accomplish in a day if you have nothing to show for it, so figure out how to make your time most effective. This will also allow for things like exercise and free time which will help you feel like school is not completely consuming your life.

Don’t be afraid to reexamine and change study habits

Going into medical school, you have to be willing to completely change your study habits. Even if you were able to study an hour before an exam in college and always make an A, that is probably not going to cut it in medical school. If simply reading a textbook has always helped you do well, you might have to change that as well, unless you’re able to read through thousands of pages a night, every night. If you tend to spend a lot of time on social media sites or watching television in between studying, you might even have to cut that out if you start to struggle. Medical school is a constant adjustment, with new terms and new professors, so you have to be willing to adapt and go with the flow in order to achieve the best results. In the future, you won’t be treating every patient the same, so there is no reason why you should treat every class the same.   

Seek help before it becomes a problem

If you enter school and you feel like you are drowning from the start, seek help! Most (if not all) schools have learning centers designed to help you succeed. They can help you discover your learning style, find you a tutor, and just about anything else you can think of. Don’t wait until you are failing to seek help, but instead get help before you even need it. At the very worse, if you do end up having an entirely bad term, at least it will be on the record that you actively sought out help and it could end up being the difference between being dismissed from a school or given the opportunity to come back and try another year.

Take a moment to sulk (but get back up and try again)

If you do end up having a bad exam, it is ok to take a moment and be upset about it. If that means fifteen minutes of crying in your car or stopping everything to take a nap, then do whatever it is you need to do. After that, brush yourself off and try again. Medical school truly is a marathon and not a sprint, so don’t dwell on one bad moment. Use it as an opportunity to figure out your weaknesses and how you can improve. Lastly, realize chances are high that you are not the only one in your class going through the same thing. Failing an exam might seem like the end of the world when it first happens, but I can promise you that years from now when you are finally a physician, it won’t even matter.

I hope this fully answers the question, but as always, let me know if I need to clarify anything. I answered the question about study habits in a previous post (which can be found HERE), so I tried not to be too redundant. But basically, my main point is to not worry about failing out of medical school before you even start, and always be willing to adjust. For the newly accepted students, take this time now to celebrate and relax, because it won’t be too long before you’re in my shoes.

A Post for the Pre-Meds: Do Upper Level Undergraduate Courses Really Help in Medical School?

Sounds like the workload is super intense! Does it really help to have taken undergrad classes like microbio, immunology, etc.? Or are you referring to your master's level classes? It seems like a lot of people say not to bother with taking more science classes in undergrad because the focus and volume in med school will be very different... but I'm wondering if it's true?

I was asked this question about a month ago, and I promised I would expand further upon my initial answer. The workload in medical school will be intense regardless of whether or not you have had previous exposure. I took anatomy and microbiology solely on an undergraduate level, and the exposure did help, but very little. Understanding the terminology is a huge part of anatomy, and without any previous knowledge, it can make things a bit harder once you hit medical school, although you will probably make out just fine. I previously took anatomy back in 2006 and retained very little of the information I was taught. What did help was being familiar with terms such as prone, supine, origin, insertion, etc. This was not taught to us in lecture in medical school, but instead it was provided as a very large word document full of common terms. Since I remembered these terms, I was able to spend more time actually learning and retaining the material than trying to understand what every other word meant. The same applies for microbiology. We are now taking it this term, and I can say with almost one hundred percent certainty that I retained less than 1% of the material taught in undergrad, but being familiar with it helps.

When it comes to classes I took in my master’s program, I can say that they are super helpful! Last term, practically every course (with the exception of anatomy) was brand new to me, and I actually had to force myself to really learn the material. This term, practically every single subject we are covering (minus pathology) was taught to me in my master’s program. In my graduate program, I focused more on learning than memorizing, and it is paying off really well for me this term. I actually feel like I have more free time this term, because I get to skip the basics. I can also say that medical school is not more difficult than graduate school in the level of the course work. In grad school, I had to literally write out mechanisms in biochemistry and I needed to learn, what felt like to me, every single, small detail about a subject. Biochemistry is way more enjoyable when you only have to know the major steps and components of glycolysis, versus having to know and be able to draw out the complete mechanisms like I did in grad school.

So what is it that makes medical school so intense? THE WORKLOAD!!!!!! Pretty much what might have taken me a month or two of graduate school to learn, we cover in about two weeks or less. This pretty much applies to every subject, so imagine an entire month of maybe 19 credit hours in undergrad, double that, condense it into one week, and you have how fast we cover everything in medical school. It is extremely overwhelming, and enough to make even the brightest students struggle. The focus is also different, but only in the sense that everything is now more clinically-oriented. This is a positive aspect to me though, because I feel like I am actually learning about stuff that is relevant to my goals as a future physician.

So, if you’re currently a pre-medical student considering taking advanced science courses, my recommendations are below. If you are not able to take some of these courses, please do not stress about it. Even if it means you will have to put in a little more effort than your peers, chances are that you will make out just fine with or without taking them. I hope this helped answer the question, and if there is anything else you want to know, feel free to ask!

Recommended Courses to Take Before Medical School

Anatomy

Embryology

Histology

Microbiology

Biochemistry

Cell Biology

Genetics

Immunology

And I’ll add to the list as the terms progress!

Improving Study Habits in Medical School

A large part of medical school so far has been finding the most effective ways to study and retain the huge amount of information that is constantly being thrown at me. I’m still working on tweaking my study habits, but since I was asked, I figured I would make a post about what is currently working for me. Hopefully by the end of the term, I will have a more solid breakdown of the things that really help, but this post should serve as a good general breakdown.

Time Management

I’ve mentioned it before, but time management is a huge part of succeeding in medical school. People constantly tell me that they don’t know how I do everything while raising a child, but I think it’s actually a really big advantage for me. While most students have the option of going home and probably taking a nap or doing other things that distract them from studying, I don’t have that luxury. Because I have a child, virtually every minute has to be accounted for. I don’t have the same amount of study hours as my peers, so I have to make every second count. It’s easy to put off studying when you have the option of waking up early to do it, but it’s a different story when you have to wake up at 6am and get your child ready for school.

What works for me is breaking down the schedule and giving each lecture a set amount of time spent studying for it. We are expected to study 5-7 hours outside of lecture, but right now I am currently averaging around five hours a day of studying. Normally one class will have had more hours than the others, so I try to devote three hours a day towards studying for that, and I give the other classes about an hour of study time. If I get out of class at 5, then that gives me one hour of study time before I have to pick up my daughter, and then my mommy/free time is typically from 6-8pm. I study another four hours from 8-12, and then I am done for the night. So far I have been good about hitting my goal, but there’s always a little extra time when anatomy lab gets out early or when my group is not going for OMM lab where I can get in some extra study time.

Practice, Practice, Practice!

This is definitely something I can improve on. The only way you can truly gauge how you’re doing on a subject is by quizzing yourself and doing practice tests. There are a ton of websites that have quizzes to help you, and so far I have found the Board Review Series (BRS) books pretty amazing. Also, make sure to go over your answers and figure out where you went wrong. I did not do this with the exam I just took, and I am convinced that at least one of the questions was very similar to one I did in the BRS book, but did not go over. For anatomy, the University of Michigan has excellent practical and written exams, and I also really like the SUNY Downstate material. I used Firecracker for about a month until my free trial ran out, and I think it’s a pretty good resource as well, although a bit pricey.

Review the Material Multiple Times

I recently got great advice from one of the second year medical students on studying, and the key point was to make sure to review the material at least five times outside of lecture. That means attend or listen to the lecture at least once, review the material three times over a semi-spread out timeframe, use the fourth time to take quizzes, and devote the fifth and final time to group studying. Even if you’re not a fan of group studying, it can reveal things to you that you might not have learned, so it’s a good thing to do if only for an hour or two. I haven’t actually done this yet, but we just started a new block and I plan on implementing it, so I will let everyone know how it works out for me after the next exam.

Ways to Retain the Information

Outside of repetition, YouTube and mnemonics have been lifesavers when it comes to retaining information. Mnemonics make it easier to remember long lists of things (ie the branches of the external carotid artery), and I find that the more dirty they are, the better they work. I have also found some amazing videos on YouTube that have explained things to me in five minutes or less despite having spent hours on my own trying to figure it out. YouTube pretty much has videos on anything you can think of, so if you get stuck on something, use that search function! I remember things that are really off-the-wall and eccentric, and some of the videos posted have all the elements needed to make the information stick in my mind.

Know What Works Best for You

 It’s important to remember that everyone has different ways of studying, so what works for me might not necessarily work for you. During orientation, I took a LASSI exam and found out that I am a strong read/write learner. I already knew this, but I learn best from reading the textbook and taking my own notes. This doesn’t work for everybody, and it is a really big waste of time to not study in a way that feels comfortable to you. Furthermore, what worked for you during your undergraduate years will probably not work in medical school just because of the sheer volume of material. Don’t be afraid to spend a month or two tweaking your study techniques until you find something that works. Also, I’m pretty sure that all schools have learning centers with people there to help you find effective study skills, so use them!

This pretty much sums up everything for now, but I’m sure I will have more posts on the subject in the future. The current term ends for us in November, and then we will start a completely different block that will consist of full days of lectures without labs. This is probably when I will have to really get a handle on things, but for now I am sticking with what I have written above. I wrote this post in terms of medical school, but I think the tips can be used by anyone whether you're in medical school, graduate school, or undergraduate school. It's important to build a good foundation early on so that you don't struggle later, so I hope this post helps!