Study Tips

Surviving Step 1: Choosing a Question Bank

By Walter Wiggins

Perhaps the most crucial component of your approach to studying for Step 1 is consistent use of a high-quality online question bank. Hitting the books certainly has its place, but if you really want to perform to the extent of your capabilities, it’ll require what author/blogger Cal Newport calls “the principle of deliberate practice.” Put simply, you have to challenge your knowledge base, identify weaknesses, and focus on eliminating those weaknesses if you want to make serious gains. The best question banks give you a realistic, exam-like experience, feedback on your performance, thorough explanations, and the ability to easily customize your experience.

There are at least a dozen question banks for Step 1 out there…some great, some not. Here we’ll focus on what I consider to be the Big Four: USMLE-Rx Qmax (Qmax), USMLE World Qbank (UWorld), USMLE Consult (Consult), and Kaplan Qbank (Kaplan). These four consistently rank among the most popular on a variety of medical student forums and websites. Choosing among them, you probably can’t go wrong. Of course, we here at the First Aid Team have a bias towards USMLE-Rx Qmax, but I’ll do my best to give the others fair treatment, as well. The qualities I consider here can be useful for comparing any question bank during your selection process. They are presented in no particular order.

Price: This may be the first thing most people consider, but it is certainly not the most important. Most question banks offer a monthly option and, at this level, the Big Four run about $99 for the first month ($75 for Consult). UWorld and Consult both offer 2- and 3-month subscriptions on a similarly increasing scale with UWorld also offering 6- and 12-month options. Most companies have reduced-price options for extending/renewing your license, should you require more time. However, the best deals for long-term use (which I highly recommend) come from Qmax and Kaplan, which both offer a subscription to their service for up to 12 months until you take the test. Qmax’s offer extends an additional 12 months or until you pass!

Number of questions: This is where it’s all too easy to be misled by clever marketing techniques. Sure, every company wants to have enough questions that you won’t be recycling back through after a month of using their product. But astronomical numbers of questions don’t guarantee that all of the questions are high quality. So, how many is enough? That depends on your intended frequency and duration of use. All of the Big Four advertise at least 2000 practice questions, in addition to extras like diagnostic tests and simulated exams. I think that’s plenty for the majority of people. I also think there’s some benefit in recycling back through questions you’ve missed, but we’ll discuss that more in a later post.

Quality of questions: This is where you really get the “bang for your buck,” in my opinion. This includes everything from the depth of the questions to the quality of the explanations provided at the end. If you really want to do well on Step 1, you need to be prepared to answer 2nd and 3rd order questions (i.e. questions that require two and three steps in logic from the initial vignette) quickly and correctly. You also need to be able to learn from your mistakes. High-quality explanations will help you identify gaps in your knowledge and/or traps inherent to the distractor answer choices. UWorld and Qmax do all of these things very well. In addition, Qmax includes images pulled directly from the pages of First Aid for the USMLE Step 1 to highlight the concepts incorporated into most of the questions.

Extras: Each of the Big Four offer additional components either included in the price of your subscription or for an additional fee. All four offer customizable self-assessment exams. Kaplan and Consult offer study books for an additional fee. Qmax and Kaplan even have subscription options that offer online video tutorials. Aside from the self-assessment exams (which I consider to be a must-have), these extras are truly a matter of personal preference and should be considered based on your individual needs and time commitment.

*On a final note, all of the Big Four employ a FREDv2-like interface, mimicking the testing software used by the NBME for the USMLE Step 1. This way, you can get accustomed to the test-taking software interface before the test and not have to worry about such trivial concerns on test day. If you’re considering a question bank outside those discussed above, make sure it’s up to this standard.


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