So many things we do in life are all about finishing. We want someone who can get the job done. We look for a real closer. We search for a person who can see this project through to completion. Our dedicated study period for the USMLE is no different — a strong finish is instrumental in your success. Come out too strong and you might burn out before that final week, leaving little left for Test Day. On the other hand, if you don’t push yourself hard enough up front, you might be scrambling in this final week, and go into Test Day a bit flustered.
So, what steps can you take to cruise into Test Day feeling strong, energetic, learned, and ready? I’m glad you asked.
1. An individualized and detailed USMLE study plan is essential.
The absolute simplest way to prevent your USMLE train from derailing is to build a sturdy and dependable track. Before you even open page 1 of First Aid during your study period, you should have a day-by-day study plan built, encompassing Day 1 through Test Day. The idea is simple, but the execution takes discipline.
You are building yourself a curriculum built around the entirety of First Aid and UWorld. Based on your own strengths and weaknesses, figure out how much time you have in your dedicated period. Devote about two-thirds to the first pass through material, and one-third to the second pass (review). Then break down each period into individual subjects based on the importance and breadth of the subject (i.e., giving more days to subjects like cardiology, and less to rheumatology/musculoskeletal). Trust me, you will feel so much more at ease with a firm plan. If you need to stray slightly from the path, this is okay, but keep yourself on a short leash. Don’t use up twice as many days as you’ve allotted to master a subject, but if you need an extra half day at the expense of memorizing biochemical pathways, this is permissible.
You will have to do what it takes to keep up! This might mean a 12 hour study day instead of the planned 10. Or forgoing watching the big game. Discipline will get you there. Your plan will ensure that your final week of studying can be spent the right way: putting the finishing touches and connecting all of your newfound knowledge... and not pulling your hair out or throwing up from anxiety.
2. Along those lines... Do the math!
Figure out how many questions you are planning on completing. A solid two passes through UWorld should do it. That’s about 4,800 questions. The same goes for one pass through UWorld and another pass through Kaplan QBank. Over the course of 6 weeks, you are looking at over 100 questions per day. You will probably want to have 0-1 study-free days per week, and other days will be reserved for NBME tests. Use these numbers to calculate an average numbers of questions per day, and do what it takes to hit the mark. You must complete thousands of questions to perform at your best. Period.
3. Firm up the topics you hate and keep putting off.
Everyone’s got their Achilles heel. What is it that you hate? Anti-epileptics? The Urea cycle? Mucopolysaccharidoses? Categorization of nephritic and nephrotic syndromes? That dread... that sinking feeling you get in your stomach when your brain involuntarily says “Ugh. A biostat question. I’m bad at these.” You can harness this negativity and sublimate it into points on Test Day with some devoted practice in the subject at hand. Your final week is your last chance to attack these topics you hate, and flip them into topics you feel comfortable with. The goal is to put in a dogged effort, focusing intently on whatever topic eats away at you, and turn it into an ally. Make it so that the next time you see it, you say, “A biostat question! I put in the effort and now I’m good at these.”
4. Cram the crammable.
While the general approach of cramming is not recommended, there are some subjects that may lend themselves more easily to last-ditch efforts to put facts in your brain. Subjects that are low-yield and based on loads of annoying one-off facts are the most crammable of topics. Some classics are your biochemistry pathways (e.g. TCA cycle, urea cycle, sweet sweet glycolysis), esoteric drugs like immunosuppressants, and biostat equations (think positive predictive values, odds ratios and relative risk calculations).
5. Start making life seem like Test Day before the real Test Day.
With 3-4 days before the test, you will want to start emulating your Test Day behaviors. Reset your biological clock so that you are at peak performance during the test. If you are slotted for an 8 AM test, make sure you are running on all cylinders early in the morning. Did you opt for the noon test? Then there’s no need to be in the zone at 7 AM. Hit your stride at the right time. Plan your meals accordingly. Give yourself breaks similar to test day. Distribute those 45 minutes now as you will during the test. If you need a big meal halfway through for brain power, do this in the days leading up to and including the test. Take seven 6-minute breaks and stuff your face with dark chocolate and walnuts if that makes your brain work better. Groom your physiology to be primed for Test Day.
6. Use the last 1.5 days to take it easy.
I tell my students to do little to no work on the day before the test, which is easier said than done. It is difficult to suppress the excitement that has been building. However, your brain deserves a rest, and you will not lose your knowledge and drive by taking a day off. In fact, the rest will likely benefit your psyche and improve your question-answering ability. If you must, go through the motions of doing a few questions to put your mind at ease. At best, you might learn a single fact here or there. The odds that this tiny fact is tested, and that it will make a significant difference in your score? Infinitesimal.
If you do nothing else to set up your final study week, remember this: The best way to finish your study period strong is to put in the effort to build a rock solid plan before you even begin. Now, fly off into the sunset, young fledglings!