The Study Tools Students Should Actually Be Using

Kolin M. Meehan

Disclosures

February 01, 2018

21,000 Questions

Once you have sat through lecture after lecture and read a few dozen review books, the time to test yourself has arrived. True to form, the overwhelming majority of American medical students subscribe to a question bank; the USMLE World (UWorld) platform is the most prominent.

Some would argue success in medical school necessitates a subscription to the ubiquitous service. Fully 90% of medical students report using UWorld for at least one USMLE.[5] But is the system worth it? Packages range from $230 to $650, potentially adding the final straw atop an average $190,000 of debt by the end of year 4.[6]

Researchers at the West Virginia University (WVU) School of Medicine found cause to celebrate, however, after demonstrating a positive correlation between reported UWorld use and Step 1 score. Users gained 14 points, on average, over their peers who eschewed the system.[7] Of note, the WVU team also identified a significant, positive relationship between a student's quartile rank and Step 1 score. University of Central Florida College of Medicine researchers identified a similar relationship between their own students' use of the question bank, grades during the MS1 year, and outcomes on Step 1.[8] Students answered an anonymous survey immediately after taking Step 1, revealing a moderate but positive association between the percent of questions correct on UWorld and their subsequent score on Step 1.

Of note, the strongest association was found between a student's Step 1 score and that of the Comprehensive Basic Science Exam (CBSE), taken immediately prior to the dedicated study period. This suggests that students ought to focus at least as much effort during the didactic portion of the curriculum as is commonly seen during the dedicated study period prior to Step 1. Overall, the question bank likely imparts a benefit to its users, but a strong foundation built up in the first 2 years remains just as crucial to success on Step 1—perhaps even more so than interacting with question banks alone.

Hybrid Theory

To date, very few products combine both raw information sources with a means of testing that knowledge all on the same platform. However, a new system hit the American market in early 2017, with the potential to shake UWorld's grip on USMLE preparation.

Created by German physicians, AMBOSS (formerly MIAMED) curates the work of dozens of physicians into a single interface originally for students preparing for Deutschland's version of USMLE Step 2. Since launching in the United States, the system now provides users with an English-language library of every pertinent topic learned during the clerkship years. AMBOSS subdivides every granular subject (eg, pediatrics) into finer categories (eg, pediatric neonatology), which contain highly specific, testable topics (eg, neonatal jaundice). Each topic breaks down further into pathophysiology, diagnostics, treatments, prognosis, and so on, such that students need only click a waterfall of tabs to unlock a wealth of information.

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