Here’s the scenario: You’re in the home stretch for your upcoming USMLE® Step or NBME® Shelf exams. You devote hours to Qbanks, practice tests, and self-assessments. You see a steady improvement week after week but then you hit a point and all of a sudden, your NBME practice scores and performance on self-assessments start to plateau. If this sounds familiar, know that you are not alone. This is a natural phase that everyone passes through when prepping for big exams (and it doesn't get much bigger than the Steps!). Most medical students face this, but only some break out of it and continue to 'make gains' by taking steps to continue to grow their knowledge base, improve test-taking skills, and get a few more points in their scores.
Let’s take a look at why your practice scores may be stagnating and what you can do to give them that final push.
1. Evaluate the study methods you are using for USMLE Step and NBME Shelf exams
The first thing to do when evaluating your study methods is to be really, really honest with yourself. There’s no doubt you’re putting in the hours — maybe even too many — but how are you spending those hours? Are you really learning and retaining new information? A crucial step to figuring this out is to check if your test-taking skills are developing. You can do this by asking yourself if you understand how the vignettes are structured and if you know what information in the question stem to look for. If the answers are no, then you may need to reassess how you are spending your very valuable time.
Here are a few examples of tried and tested study methods that may help unlock the period of stagnation and get you back on track.
1) Ask yourself if you are incorporating enough practice questions into your study sessions. It has been suggested that the most surefire way to achieve success on the USMLEs is by answering as many unique questions as possible.
2) What do you do when you get a question wrong? Going over your incorrect answers is a great way to turn weaknesses into strengths and bridge any knowledge gaps (and be sure to check out the AnKing's video tutorial on how to approach missed questions and make Anki flashcards for them!). As every student is different and absorbs information in different ways, it’s important to find the best learning method for you. Here is one solid method for learning what you missed in a question session that may work for you:
- When you get a question wrong (or are practicing any topic), read the related AMBOSS article for the topic at hand.
- Create or unsuspend an Anki flashcard on the topic.
- Reinforce your understanding with a related video.
- Answer another related Qbank block to test yourself and see if your understanding has improved.
This method is useful as it incorporates both active and passive learning, improves memory retention, and flexes your critical thinking muscles.
Always remember that the most important aspect of learning in medicine is to really understand the material and not just learn it by heart.
2. Remember that no one can learn everything: focus on your weakest areas to improve your NBME practice scores
This may sound obvious, but it’s very important: identify your weakest areas. These are often the topics that you’ve been struggling with the weeks before the exam. If you’re not too sure what your weakest areas are, you can use the AMBOSS analysis to identify them.
The AMBOSS analysis section (found in the dashboard when you log in to your AMBOSS account) gives you a complete overview of your latest Qbank session or your overall Qbank history. If you don’t have a comprehensive analysis, do a Qbank block on an area that you find challenging and your analysis will grow and become more precise from there.
For an in-depth look at how to use the AMBOSS analysis, take a look at this blog post.
While it’s important to focus on improving your weakest areas in the final weeks of prep, you should also stay on top of the other topics that will be tested on exam day. Even doing one block per day on other topics can help keep them fresh in your mind while you improve the weaker areas.
3. Look after your mental and physical well-being
This is really number one. There is nothing more important than your health and well-being. Medical school and residency put an inordinate amount of pressure on med students and physicians. With high expectations, lots of information to learn, and clinical skills to develop, it’s no wonder that students can hit a wall in their studies.
Thankfully, there are steps you can take to manage the stress of medical school and take really good care of yourself. Not only is this vital for your own well-being, but it will also help you be more relaxed, retain more information, and be less stressed in the exam environment.
The first step is to ensure you get enough sleep. Recent studies have found that there is a correlation between getting regular, good quality sleep and better grades. So, while it may be tempting to stay up late (or pull an all-nighter) studying, this may have the opposite effect than what you intended.
Taking regular breaks is another way to prevent burnout and ensure your own positive well-being. Schedule breaks into your study routine and, during this time, do something that you enjoy. Remember, more hours spent studying don’t always lead to better grades.
For more tips on how to prevent burnout in medical school while still achieving all your goals, check out this blog post here. You can also find out more about how medical students and physicians can use mindfulness to alleviate psychological distress in our article here and practice with our mindful breathing video.
4. Optimize the timing of your practice tests
As we already mentioned, answering as many unique questions as possible is one of the most successful strategies for USMLE Step and NBME Shelf exam success. And there’s no doubt that taking practice exams is a great way to get a feel for exam day. However, completing one self-assessment straight after another may not be the best use of your time.
Ask yourself if you are leaving enough time between practice tests to really learn new information. If there were a few areas that you struggled with in your last practice test, did you spend time learning and really understanding the material? If not, make sure you do this before moving on to the next self-assessment.
Your exam date is another consideration. While it’s not recommended to consistently push your exam date, if you’re going for a competitive specialty and your scores are much lower than they need to be, consider extending the date. If you do decide to extend, make sure you use the extra time fruitfully and adapt your study methods. You can also check with your school administrator or mentor to decide on the best course of action.
While stagnating NBME practice scores can be frustrating, try not to become discouraged. You’ve already come so far in your medical career and that doesn’t happen by chance. You have the skills and the ability to get the grades you want. Try to focus on really understanding the material, ensure you cover the topics as detailed in the exam content outlines, and, most importantly, don’t forget to take breaks and look after yourself. The rest will soon follow. You’re going to do great.
Whether you're sitting Step 1, Step 2, or Shelf exams, we have a tailored study plan for you. Try it out today and feel confident on exam day.
