Effective study for the Step 1 of the United States Medical Licensing Examination (USMLE) is not simply an exercise in effort, nor can test-takers simply rely on their natural aptitude to earn a passing grade. An evidence-based approach to one’s preparation, using methods that education researchers have deemed most effective, can yield the best results.
A recent research poster presented during the ChangeMedEd 2023 conference examined the most effective approaches to USMLE Step 1 study in the e-learning space. The results shed light on how students can best prepare for the milestone examination.
The poster’s co-authors offered insight on their findings and how they can be broadly applied to medical students’ USMLE study plans.
Understanding what works
Lecturio GmbH is a Germany-based medical education e-learning company that offers online learning resources for USLME prep. Lecturio’s online offerings are paid products and neither this article nor the research poster’s inclusion at ChangeMedEd 2023 are meant to imply endorsement of the AMA.
The research poster analyzed how users interacted with the platform and which of those interactions yielded the best results on USMLE practice examinations.
A total of 216 test-takers participated in a Step 1 self-assessment and mock testing event. Data examined 16 usage behaviors related to Lecturio’s quiz feature, question bank (Qbank), and video lectures. Of those 16 behaviors, three proved most effective: number of quiz answers, the number of Qbank answers, and quiz-answer accuracy.
“If you are using an e-learning platform, these are the behaviors you should reinforce if you want to do well in your exam,” said Satria Nur Sya’ban, MD, the poster’s co-author and a a medical education consultant for Lecturio. “Our findings are generally aligned with what the literature says about good study behaviors.”
Following the formula
Lecturio’s Qbank—case-based questions in vignette format—and multiple quiz questions rely on two key concepts that portend effective study: spaced retrieval and active learning. Qbank questions are more case-based or vignette style multiple choice questions and require more clinical reasoning skill.
Quiz questions are simpler multiple choice questions that ask learners to recall information.
In learning, the concept of spaced retrieval suggests the concept of spaced retrieval suggests that covering a topic once, or testing oneself on it, and then returning to it after some time is one of the most effective methods to ensure long-term retention. On e-learning platforms, the quiz and Qbank functions often build spaced retrieval into their functions. But it can also be applied manually with tools such as flash cards.
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“The key aspect is the temporality of it. Students need to allow for some distance between one retrieval and the next to maximize its effect,” Dr. Sya’ban said.
USMLE study can involve a combination of passive methods, such as watching a video lecture, and more engaging activities such as quizzing yourself with a classmate or a Qbank.
“If I'm lecturing you and I tell you a fact, you may or may not remember it,” said Sara Keeth, PhD, Lecturio’s director of learning and institutional success, who co-wrote the poster. “But if we’re playing a trivia game and I ask you a question, by trying to come up with the answer, the fact that you tried to recall that answer—even if you get it wrong—is going to help you remember the correct answer the next time you have this question.”
Confirm your methods
Whether it is via an e-learning platform or an offline method such as a group study or flash cards, both Sya’ban and Keeth said that it’s vital for students to follow evidence-based techniques in their USMLE prep.
If you are uncertain of your methods, medical schools generally have faculty members and advisers—often in student affairs departments—who can point you in the right direction.
Keeth did offer a word of caution for those who may have used study methods that don’t align with the science on what works. The USMLE Step 1 is unlike any other standardized test a medical student has previously taken. Methods such as improperly planned rereading, indiscriminate highlighting and especially cramming simply will not be enough.
“Maybe a student used less effective study techniques in high school or as an undergraduate, and they got away with it because they are really high achievers,” she said. “When the level of the material gets so much more difficult and the amount of the material grows so much, sometimes those less effective techniques aren't getting them where they need to be. That can be really frustrating if that's the first time that's ever happened to you. So some people panic and cling even harder to their ineffective techniques.”
