How to Prepare for the USMLE: Statement of Goals

What you want to do with this test, with this opportunity, is up to you. However, if you’ve googled the topic and are reading things like this, chances are you’re not looking to coast with a modest passing score. I, sure as shit, am not. I want to keep as many doors open as I can for my residency interviews and I know that coming from the Caribbean puts me at a disadvantage.

People come down to the school to tell us things like, “The passing score is now 185. If you want a residency program that has empty slots each year like Internal Med or Family Practice, that score is fine. But if you want anything even mildly competitive, don’t show up with anything below 215. Don’t even bother applying. At that point, your best bet will be to sign outside of the match. Remember that there is a difference between having a score good enough for a residency and having a score good enough for a competitive program in that residency. It is always better to have a better score, regardless of your goals.”

In light of all of this, I’m going to state my goals and try to put everything that I’ve written about my preparation into context. When I say that the BRS questions are weak or that for a certain book the topic was covered superficially, I mean that it was weak and superficial for what I want to do. I do not want to just pass the Boards. I don’t even want a high pass. I am locking myself in a library every day to score above the 95th percentile. If you glazed over a subject, feel weak in it, and could use a stepping stool to competency, then the BRS Path (for example) is fine. But if you’re reaching for the brass ring, you should just sit down with Pocket Robbins or the Merck Manual and take the time to really get into it.

Yes. I know that you know a guy that barely studied and got a 99. Yes. There was a guy that did nothing but review the First Aid and he also got a 99. If you’re going to be the kind of doctor whose decisions are swayed by anecdotes like this, then you probably need to review Epidemiology and Study design. As far as I go, I’m not willing to follow their examples because, regardless of what they accomplished, I’m not that guy and you probably aren’t either. So let’s just dispense with the bare bones approach.

Reviewing this stuff (cramming) without achieving deep understanding at each level (internalizing) is like renting an apartment for a month at a time when you know you’re living in the neighborhood for the next ten years. Why waste your money? Instead of paying just enough each month, it’s worth it to go into debt (time-wise) to own it. Every day after that, the investment pays for itself, but you have to make it that first time. I’m not here to rent the knowledge; I’m here to own it, and every criticism I ever make of review materials is in that light.

There are books that I’m going to really like because of their incredible (but necessary) detail or because they are exceptionally well-written. There will be books that I trash for being riddled with errors and grammar mistakes or for being superficial to the point of uselessness. But whatever conclusions I reach, yours may be different because of time constraints (I have the luxury of two months) or learning style (in the eyes and it stays, in the ears and its out the other).

State your goals. Have a plan. Set a Schedule. Buy your books. Pick a QBank. Don’t crack. Have fun.


I think it’s now worth saying that of all the things I’ve done so far, bringing the Merck Manual to the library every day has been the best decision. I left it at home one day because it was taking up too much space. I am never doing that again. Pound for pound, I don’t own anything more useful. In fact, I’ve decided that from now on I will rate everything in units of Merck. Let’s establish a scale:

18th Ed. Merck Manual = 100 Mercks = highest rating.

Dudeck’s HY Cell and Molecular Biology = 1 Merck

“Dudeck” might be its own scale, sort of an inverse to utility… like a feacalith.

Return to USMLE Step 1 page.


2 Responses to How to Prepare for the USMLE: Statement of Goals

  1. Panda Bear says:

    I understand what you’resaying and I also agree that the best way to do well on the test is to understand the material on a deep level. However, if you haven’t reached this sort of deep understanding after two years of medical school, how are you going to do it in a a few weeks of cramming for Step 1?

    I am the worst student in the world, bottom of my class in all respects, and slacked my way through all of medical school but got respectable Step 1 and Step 2 scores. Doing practice questions is the only way to conquer that sucker. Reading text books, hell, even reading BRS is so low-yield that you will probably find yourself sitting in the test saying to yourself, “Holy shit, it’s like I didn’t even study.”

    They’re not testing you on deep knowledge or on how good a doctor you are. They’re basically playing a complex pattern recognition game which has never-the-less as it is written for students from 125 different medical schools has to be stnadardized to the point that if you do enough practice questions you’ll cover everything you need to know. And you’ll spot the patterns.

  2. JJ says:

    I know that it is over 2 years since the last post, but I couldn’t agree more with Panda Bear in terms of the calculus of the step. At the same time, understanding the material accelerates the learning garnered by hundreds of practice problems. They go hand-in-hand. The moral/point of this post is that you should never forego usmleworld questions to read a more detailed textbook while reviewing for step.

    It is too late by that time. The last 6 weeks before step is all about efficiency, not for patching up gaping holes that took 1+ year to create.

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