Questions are the heart and soul of the USMLE. Getting ready for the exam means doing questions as practice to prepare for the questions that count on exam day. Although questions are the target at the end of your preparation process, doing practice questions will not, by itself, get you ready for that big day of the exam.

Doing well on these exam questions requires two things: 1) a sufficient fund of knowledge and 2) a well-honed technique for dealing efficiently with the presented questions of the exam. Just doing as many practice questions as possible will not give you either of these two. Successful preparation depends on the adept blending of activities, not simply doing a lot of one thing. And doing each stage of preparation well, matters much more than how much time you spend preparing.

Doing questions will not give you the fund of knowledge that you need. But using the insight you gain while doing questions can guide you to the knowledge that you need to learn. Questions do not teach you. Questions test you. Questions tell you what you know and do not know. Your job is to take this insight and act on it.

Most practice questions of any merit come with annotated answers. In the best instances, these annotated answers tell you both why the right answer is best, and also why the other options are inferior. Reviewing the annotated answers should help you to grasp the key features and essential logic of the question. This is truly valuable information. But your exam preparation requires more than the nuggets of knowledge embedded in these annotations.

Question annotations give you little bits, atoms, of knowledge. The problem is that each little piece of knowledge floats around free, without any linkage to other important content. Annotations help you learn the knowledge important to the questions, but not how to use that knowledge in a broader context.

To achieve the level of understanding the USMLE demands, your knowledge must not be in atoms, but molecules. Facts must have context. Details must be associated with key ideas. Each individual piece must fit together to reveal the larger patterns. Questions annotations give you the pieces, but do not help you see how the pieces fit together into the frame of a larger puzzle.

To gain this larger perspective, after reading the annotated answer you must open you content study material to the topic featured in the questions and review the content in context once more. If you do not know the content, go back and look at it again. By going back to your basic study material, you will have the chance, not only to learn the specific points tested in the questions, but also related issues which will embed the question in your larger framework of knowledge.

Doing large numbers of questions will not teach you do to questions well. The trick is to learn to do questions well, before you do a lot of questions. If your technique for reading and answering questions is flawed, then doing a lot of questions will simply reinforce these bad habits. You will become highly skilled at bad question answering behavior.

Start doing practice questions slowly. Initially, work on having the right process, and don’t worry so much about whether you get the questions right or wrong. At the start, it is more important that you learn to do the questions the right way than if you select the right answer. When the proper questions answering technique has become a comfortable habit, then, and only then, should you ratchet up the number of questions that you do each day. Once you have the proper technique, practicing it more and more questions will make this good habit second nature. And when you questions habits are second nature, then your mind is free to focus on the content issues of the question.

Doing practice questions is essential and annotated answers are great. But, successful USMLE preparation requires more than these simple resources. Do not neglect the hard work of content study, and learn to do questions right before you do them in volume.

Steven R. Daugherty, Ph.D.

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