How long should I study?: It’s What You Do with the Time That Counts

Does extending your study time add points to your USMLE score, or does it actually hurt because you will start to forget what you already learned?

If you believe that USMLE preparation as a brute memory exercise, then you probably think that at some point the new stuff you learn will be negated by the old stuff you forget. When that balance point is reached, further study would not provide any real benefit. Once your memory is saturated, additional study would gain you nothing.

But, the focus on the USMLE as a pure memory exercise is misplaced. USMLE test items are not questions to be answered, but problems to be solved. You get the top score, not by regurgitating what you have taken in, but by being able to use that information and apply it to the situations each question presents. In short, doing well requires thought, not brute memory. Shear memorization does not get you that high score. Something more is required.

You get to this problem-solving level by changing what you do with the material you are studying. If you fell that you are studying hard but not progressing, it is time to change your approach to the material. As you learn more, you can do more with the material you have learned. Figure 1 (below) illustrates the essential point.

Initially, study is about memorization, but after a while you will find that you have gone as far as memory can carry you. To solve this impasse you need to shift to a focus on how things fit together within each subject you are seeking to master. Gaining a sense of connections and linkages among the things you have learned will help you see things in another light and make it easier to retain the things that you have already memorized. At this level you focus on learning patterns, that is, no longer learning things, but the relationships among things. Every medical subject area is defined by a set of essential patterns and templates which give a context to all the details and help them to make sense. Pattern recognition helps you focus on these most essential elements and moves you up to the next level of USMLE scores.

To get to the highest level you must move beyond pattern recognition within subjects to an integrated understanding of the connections between basic subject areas. All medical knowledge is about the same human body. All clinical issues can be approached from a variety of medical disciplines. Gaining an understanding that multiple approaches are possible to solving a presented problem, and acquiring the ability to select the must useful of the available approaches in any circumstance is the mental habit of mind required to achieve the highest level of performance.

Memorization only lifts you so high. Pattern recognition within subjects gets you higher. Understanding of how content is integrated between subjects moves you to the highest level. If you use added study time to shift to the next level, you will find clear improvement in your score. If you use added study time to simply focus on more and more memorization, you will fins you improvement has stalled. The key to progressing is not how long you study, but in shifting what you do as you study across time.

So, how long should you study for the USMLE?

The length of time you will need to study for the USMLE differs from person to person and depends where you are in your study process. If you are still at the level of memorization, longer time will be required. If you have advanced to pattern recognition, then somewhat less is needed. When you have achieved the level of integrated understanding, you are ready to take you exam.

In short, the optimum study time varies widely depending on the strengths and weaknesses of each individual. We can, however, offer some general guidelines to guide your planning.

As a rule of thumb, it takes about 2 to 3 months to prepare for each USMLE Step. Additional time may be required if you:

1. Have been out of medical school for more than 1 year. Information fades over time. The longer you have been out of school, the more time is required to boost your knowledge base back up to where it needs to be. In addition, the thought processes required for USMLE questions are a bit different than those of actual clinical practice. Most people find they need time to get back to thinking in the appropriate ways.
2. Had any academic failures in medical school (or barely passed two or more courses). Academic difficulty is clear evidence that you have some gaps in your knowledge base that will damage your USMLE score.
3. Learned English after age 10. PET scan studies have shown that language learned prior to age 10 goes into Boca’s and Wernicke’s areas, whereas language learned at a later age goes into contiguous areas. This means that language learned later in life comes with slower processing speeds which can slow you down measurably on the USMLE. Everything you do to become more proficient in English will improve your score. Make sure you spend time increasing English comprehension and reading speed by taking time to practice reading in addition to you USMLE study time.
4. Have a history of difficulty with focus and concentration. If you have actually been diagnosed with ADHD, or just have difficulty with maintaining your attention for prolonged periods of time, you will likely require more time to cover the mass of material required for the USMLE.
5. Have other responsibilities during the time you are studying. If you have family or work responsibilities, you will not be able to give you full attention to your USMLE preparation. Part-time study simply means that you more months will be required for you to review and master the required material.

On the other hand, you should be able to shave time off of your preparation if you: 

1. Are still in medical school
2. Excelled in you courses
3. Have a past history of performing well on standardized exams
4. Enjoy puzzles and thought exercises

The good news is that you can take whatever time you need to get ready for the USMLE. Don’t let friends, family, or your school push you into taking the exam when they think you should. To be master of your own fate, you need to decide if you are ready or not. If you decide you need six months, take the six months. Remember that once you pass, you can not try again to improve your score! My own experience with students suggests that if you think you need more time to study, you probably do.

Take the time that you need. Force your self to move beyond memorization to pattern recognition and subject integration. Change how you learn as you learn more. Shifting how you learn is the key to stepping up to that higher USMLE score.

Steven R.. Daugherty, Ph.D.