How to (Virtually) Guarantee a Step 1 Pass (Step-by-Step Guide)

Passing step one isn't just about doing 500 Anki cards and 100 UWorld questions every day. Most students who fail actually do more questions and have done more Anki cards than those who pass. The difference a systematic approach where you can clearly see your scores improve rather than random effort hoping for magical NBME results.

By implementing these 10 critical steps, you won't just virtually guarantee a step one pass. You'll also substantially improve your shelf and step two scores, putting you firmly on the path to matching at your dream residency. I've seen students transform from consistent practice test failures to comfortable passes using this exact system, some in just weeks.

Today, I'll reveal a step-by-step plan to eliminate the fear and anxiety of board exams, give you complete confidence in your abilities, and provide the structured framework top performers use to match at their dream programs. Step one is to aim for 80% mastery before moving on. The biggest mistake I see failing students make is that they try to copy what others are doing on the surface without understanding why it works underneath.

Success in step one requires proving your approach works before you scale it up, not blindly imitating what worked for someone else. First, let's understand why students get into trouble in the first place. Most struggling students make a critical error.

They look at what successful students are doing in their final weeks or maybe months of test prep. Schools have a tendency of perpetuating this since the top students typically are the ones that are doing 50, 60, 100 questions a day. Or you may have read those success stories of someone who scored a 260 plus on step two and what did they do in the last few months of studying.

The problem with this is it's like asking LeBron James what he did the week before the NBA finals. It ignores the years and decades of deliberate practice that came before that. Service level imitation, meaning, oh, okay, this person scored a 70 on their NBME and they passed.

they were doing a 100 questions a day and they were doing subject level exams and without really understanding the underlying system is going to virtually guarantee that you won't get the same results as that person. The most dangerous part of just copying how many questions someone did is that this approach offers no feedback mechanism to know if your studying is actually working. Instead, the 80% mastery principle is your path to guaranteed improvement.

If you fail step one, there's a lot of residency programs that are going to reject you automatically. Before you take your next attempt, you need concrete evidence that your study methods are actually effective. It means that before you move on, you should plan on scoring at least 80% on whatever that topic is before you move on to the next topic.

Let's consider some simple math. Let's say that you're currently at 50% overall or thereabouts. If you master just half of the exam content and you get that to 80%, the average score now becomes 65%.

Right? That's just the mathematical average of 50% and 80%. A 65% corresponds to approximately a 95% chance of passing step one.

What I see a lot of people do is that they'll get through all of UWorld and they're scoring maybe about 50 or 60% and then they're just hoping that magically their score is going to jump to 65 or 70%. You can with reasonable accuracy predict what your overall score is going to be if you look at just what are the scores of the things that you're learning plus look at how much you're forgetting. If all you do is make sure that you get 80% and you make sure that you never forget it by using space repetition, you can virtually guarantee whatever score it is that you want from your starting score of maybe it's 40% or 50% all the way up to that 80% mark because if you want to get a higher score, you just have to study for longer.

Most importantly, this approach gives you certainty rather than just hope. So why do most people not do this? Well, the fear of not covering everything is usually what keeps students from jumping between topics.

There's something very satisfying about doing a hundred questions a day and feeling like you're making real progress because you can see that number creep up. The problem is is that comprehensive coverage without depth is the perfect recipe for failing step one. True learning comes from mastery, not just being exposed to the material.

The 80% approach gives you permission to be thorough rather than just having superficial understanding. Next, let's talk about the first critical framework that you need to master in order to start hitting that 80% threshold. Step number two is the context chronology severity framework.

This framework will transform how you read vignettes and immediately improve your accuracy. Every step one question contains intentional clues that most students miss because they don't understand the test writer's mindset. Let's start with context.

This is the relationship between all of the clues that they're giving. Generally, 50% or more of missed questions have nothing to do with knowledge gaps. If you've ever studied something and gotten it wrong, or you look at the answer explanation after you've gotten something wrong and you're like, "Wait a minute, I totally knew that.

" Then you know what I mean. In order to understand the importance of context, remember that there are very very few if any symptoms or lab values in medicine that by themsel is truly pathonneic. Instead, test writers mimic the real world and that they design questions where you need multiple somewhat specific findings in order to create diagnostic certainty.

So for example, headache is very non-specific, visual changes also relatively non-specific, papillma is more specific, but still there are multiple things that can cause papadema. However, if you put all of these three things together, you realize, oh, okay, there's probably increased intranial pressure. In order to make these connections on your test and move towards that 80% threshold, so you can virtually guarantee passing step one.

For every sentence that you read, ask yourself, why did they include this? How does it relate to other clues? What this does is it prevents the common error of fixating on a single finding and missing the big picture.

We've all been guilty of anchoring or looking for buzzwords, hoping to find that one single clue that tells us everything. To counteract that, ask yourself, what does this mean in context? And try to connect that fact with the others.

Next is chronology, putting the timeline in order. Step one, test writers are deliberately going to scramble the timeline to test your clinical reasoning ability. To maximize your chances of getting every question correct, you want to always mentally resequence the vignette into chronological order before deciding on a diagnosis.

A 22-year-old male presents with jaundice. He attended a music festival 3 weeks ago. He reports fatigue for the past 2 weeks.

by itself, you may be able to figure out what's going on. However, what if I reordered it? A 22-year-old male goes to a music festival.

A week later, he starts having fatigue. 2 weeks after that, he has jaundice. When I put it in this order, music festival leading to fatigue leading to jaundice.

Now, hepatitis A becomes a lot more obvious. This chronological reordering is particularly crucial for infectious diseases, drug reactions, cancer workups, where the timeline and the temporal relationship is particularly important. When students skip this step, they often miss the positive relationships between events.

Finally, severity helps you narrow management options. While management makes up almost half of step two questions and is a significant part of step two, clinical decision-making questions have started to show up in step one more in recent years. To give yourself a leg up on these questions, you want to recognize the severity of the presentation and specifically know that the more severe the presentation, the more aggressive the management is going to be.

Even if all you're doing is preparing yourself for your shelf exams, which you're going to have to take immediately after step one, or for step two, which is going to be the scored exam that's going to determine a lot of your residency application. Severity is critical. So, let's look at some severity clues.

The first is the location that the patient's presenting in. Are they in the emergency department? That would be pretty severe.

On the other end of the spectrum, you may have a patient that's presenting for a work physical or they are a pediatric patient where they need to participate in gym and so they have to do a physical for that. Those would be examples of patients that are very asymptomatic. The problem that they have isn't symptomatic enough that they would even go to the doctor in order to check it out.

They're there for other reasons. Other signs of severity include vitals, mental status, right? If they've got problems with the functioning of their brain or they've got end organ dysfunction in some other capacity like low urine output to show that there's some sort of kidney dysfunction.

These are all signs of severity. In addition, even if they're not going to ask you a management question, it's important to understand the purpose behind each of these sentences because the greater that you're able to get into the mind of the test writer, the higher the likelihood is of you getting that or any other related question. This framework eliminates confusion between answer choices like reassurance or immediate intervention since the less severe presentations again are going to have less invasive management.

Now that you know how to read vignettes properly, let's tackle another crucial technique that prevents careless errors. Step three is to create a standalone question. This technique will instantly boost your step one performance regardless of how much knowledge you know.

One of the biggest mistakes I see is that students look at answer choices way too early in the process. Doing so can cause confusion and can lead to wrong answers even when they know the content. So what is a standalone question?

A standalone question by itself should stand alone. Meaning if I came up to you on the street and I asked you only the question and didn't tell you anything about the vignette and I didn't give you any of the answer choices, you could still answer it unambiguously. Here's why this approach works so well.

Answer choices are deliberately designed to create confusion and to test your certainty with your answers. When you look at the answers first before you think what is the question really asking me and in particular before you start thinking okay what answer should I be looking for you start playing the matching games instead of actually using clinical reasoning. This technique of identifying the question and the answer before you look at the answer choices forces you to commit to a diagnosis or a principle before you start being influenced by all of the other choices.

It also prevents the common problem of wavering between choices and second guessessing yourself. If you've ever been stuck between two answer choices and chosen the wrong one because you started to doubt yourself on the one that you favored originally, this technique can be remarkable. So, here's exactly how you do it.

First, read the vignette using the context chronology severity framework. Then, cover the answer choices or scroll up so you can't see them. Ask yourself, what exactly are they testing me on?

What's the diagnosis? What's the principle? Once you've identified what they're asking you, formulate your answer in a complete sentence before looking at the answers.

Then look for the answer choice that best matches your formulation. This prevents the common error of seeing an answer that partially fits and then convincing yourself that that must be correct and selecting it prematurely. The next technique builds on this and helps you to avoid a common trap with answer choices.

Step number four is to rule in before you rule out. Our first instinct when we see answer choices is to start eliminating options and this leads to preventable mistakes that are hurting our score. Let's understand why this instinct is problematic.

When we focus on ruling out first, we often eliminate correct answers for incorrect reasons. Right? Have you ever gotten a question wrong where you looked at it afterwards and you saw that you had crossed out the correct answer?

The reason for this is is that we can always think of reasons why something isn't correct. Many students like me who have ADHD or anxiety are especially vulnerable to this mistake. I used to do this all the time.

We can know the content perfectly but still miss questions using this approach. For the average student, this might be up to 15 or even 20% of the errors that they're making. These are the easy points that you need if you want to maximize your chances of passing step one and to get the highest shelf in step two scores possible.

I was working with a student where they were looking at a patient that had a clear DVT. It was a posttop patient and they were already on prophylactic hepin. One of the answer choices was therapeutic hepin.

Now, the student immediately ruled out hepin. She said, "No, well, the patient's already on it, so it can't be therapeutic hepin. " The problem is is that she failed to consider that prophylactic and therapeutic heperin are actually completely different.

Dosing is different, the uses are different. The answer ended up being therapeutic heperin. This was a question that they knew the content for, but they missed it due to an approach issue.

They were looking for reasons to rule things out first, and they specifically eliminated the correct answer choice because something just felt off. Here's what you should do instead. Rule in before you rule it out.

For each option, first ask, why would this answer be correct? In what scenario would this be right? Only after you consider why it might be right, then consider why it might be wrong.

In the case of the student with the DVT question, she would have said something like, okay, well, therapeutic hepin, hm, I mean, therapeutic hepin is the thing that you would use for a DVT, and so I guess that does make sense. The rule out is, well, I guess it is different from prophylactic hepin, so I guess that would make sense. You want to do this for every option on every single question until it becomes automatic.

Now, in the beginning, this is going to feel extremely slow. However, just like everything, it's going to be slow in the beginning, but as you do it more and more, you're going to become more comfortable and it's going to become faster. This simple technique can improve your score by five or even 10 points.

I had a student recently who was scoring below passing on her NBME and in about 3 weeks, she improved her score by about 20%. Mainly in using question interpretation like context, chronology, severity, and standalone question, and especially doing gruelin and rule out. Now, let's talk about how to break down the overwhelming challenge of step one into manageable pieces.

Step number five is to break down big problems into micro skills. The most frustrating thing for struggling students is knowing that something's wrong, but not knowing exactly what to fix. Often times, it's the way that we're framing problems that's the reason that we're being held back.

For example, if I say, "I'm bad at questions," then it doesn't really give me any clear path for improvement. Instead, I want to identify the micro skills that I would need to improve in order to work on that macro skill of being better at questions. So, why is it important to break down a big skill like test taking skills into all of the individual micro skills?

First, vague goals produce vague results. If you have specific targets, it's a lot easier to create measurable improvements. Often, struggling students will say things like, "I need to get better at cardiology.

" Instead, for students that see the fastest improvements, they'll say something like, "I need to improve my ability to distinguish between systolic and diastolic heart failure. " In other words, instead of saying, "I'm just bad at cardiology," they're identifying a micro skill or a micro bit of knowledge that will allow them to improve via deliberate practice. This is how some students make massive improvements seemingly overnight.

So, you may be wondering, how do I identify my specific weaknesses? To do this, after each practice block, you want to categorize your errors into specific types. First, you want to look at content knowledge gaps, things that you just didn't know.

Second, you want to look at application errors, things where you knew the fact, but you couldn't apply it. Next, look at your standalone question. Did you misunderstand what was being asked?

Were you able to identify or predict in the educational objective what the educational objective was going to be? In addition, how many times did you get stuck between two answer choices and choose wrong? If this is happening to you, you may be being too critical of one of the answer choices.

In other words, you're being a lawyer as opposed to being a judge where you're looking and balancing both answer choices side by side and asking, "Okay, well, neither of these answers is perfect, but which would make more sense in the context. " Finally, look for time management issues. How often were you rushed and missed clues because you were reading the questions too quickly?

If you want to get really fancy, you can ask JPT to make a frequency chart so you can see the patterns in your mistakes. Ultimately, you want to find the highest frequency errors since these are the things that if you fix, you can improve your score dramatically. We had a student who had failed his step one.

He had basically gone in less than 2 months from the bottom 3% to the top 3%. In other words, a four standard deviation improvement basically by identifying all of the errors that he was making and always looking for the biggest highest leverage mistakes to fix. Specifically, when we did an analysis, we found that he wasn't weak in all of the areas.

In other words, he had specific weaknesses. He had weaknesses in chronology identification. He had issues with answer choice elimination and he had some gaps in basic physiology concepts.

What we did is we created targeted exercises for each of those micro skills and built flashcards for each of the knowledge gaps. He ended up with a 92% on his NVME not from magic overall improvement but just systematically fixing his individual weaknesses. Despite having failed step one, he actually matched into urology which is a super competitive field and is typically not open to people that have failed step one.

However, because he had such a massive improvement in his scores, the programs were able to overlook his failure in step one. Now, let's talk about how to overcome one of the biggest barriers to step one success, procrastination and feeling overwhelmed. Step number six is just start small.

Perfectionism and the all or nothing mentality destroy more step one study plans than any content difficulty ever could. In order to understand how to overcome it, let's understand why we procrastinate on studying. Our minds react to psychological threats in the same way that our bodies react to physical threats.

In other words, if something feels uncomfortable to us, we are going to either fight or flight. In that vein, procrastination is really just us running away from things that make us uncomfortable. So, let's look at the reasons why we might be uncomfortable in the first place to understand how we can overcome procrastination and get more stuff done in our days.

Often times, we're looking for perfection where really we just need to grind. So, for example, have you ever woken up late in the morning and thought like, "Oh my gosh, h I wanted to wake up earlier and because I didn't wake up earlier, now I'm already behind on everything, so h it's just not even worth it. " And uh I guess I'll just stay in bed and just keep scrolling or whatever.

There's a gap between our ambitions and reality, and this creates anxiety. That anxiety triggers our fight or-flight reflex, which really is just going to cause us to procrastinate. The procrastination that makes us avoid studying also creates more anxiety, which creates a vicious cycle.

So, how do we break the cycle of procrastination and get more done so that we can virtually guarantee that we're going to pass step one? For this, I call it the one push-up rule. A famous opera coach told me once that if I wanted to do 50 push-ups, the way to do it isn't to start by saying, "I want to do 50 push-ups.

" Instead, I should start by saying, "I'm going to do one push-up. " The reason is is that the hardest thing to do in most cases is just to get started. So, instead of saying, "How am I going to do 50 push-ups?

" Ask myself, "What's the smallest version of this that I could be doing right now? " If you've been telling yourself, "Oh my gosh, I've got to do 40 questions. " The idea of doing 40 questions might be so overwhelming to you that you procrastinate.

If you just say, "I have time to do one question. I'm just going to do one question. " You'll get it done.

Remember, doing one question properly is infinitely better than 10 that you never even attempt. So, here's how you can implement this to get more done every day. First, start with doing just one or two timed questions a day with perfect execution.

Next, gradually increase this number as you build momentum. If you find small pockets in your day, just do one anki card. Maybe it's before rounds.

Maybe it's during lunch. Maybe it's instead of scrolling. Just set a timer for yourself for one minute or two minutes or five minutes.

And just see how much you can accomplish. Remember, small wins create psychological momentum and confidence. I told myself I would get two questions done today and I did.

Feels much better than I didn't study again. Okay, so now we've got a plan. Before we scale up our approach and try to do more, let's make sure that it's actually working.

Step seven is to test small before scaling. The biggest mistake I see is students implementing full-scale study plans without first testing if their approach produces results. When I was at Stanford as a medical student, the learning specialist would sit down with basically every medical student before they started step one studying.

They would then create this elaborate 8week study plan where they would lay out how many questions they were going to do every day and what parts of first aid they were going to read and what other sorts of resources they were going to use. The problem is that they set up their plan without knowing if their methods were actually going to work. Smart students test their approach on a tiny scale first before committing.

In business, this is a really, really common technique in Silicon Valley that they say fail fast, fail often. The idea is is that they're trying to validate the approach first before they invest huge amounts of resources and time in other things. A 2-day micro test of your approach tells you a lot more than 2 weeks of undirected studying.

This prevents the all too common tragedy of realizing that your approach doesn't work only when it's too late. So, how do you conduct a single topic validation test? First, choose a self-contained topic that doesn't require much outside knowledge.

For example, I really, really like coronary artery disease for this. The reason is is that you don't really have to understand any other parts of the body to understand that there are vessels that feed the heart and if those vessels get blocked, it's going to lead to necrosis or death and that death is going to lead to inflammation that's going to have to come and clean it up. You want to study this topic thoroughly using your planned resources and methods.

I recommend going through the entire section for eskeemic heart disease and first aid and making flashcards on all of the knowledge. Then test yourself with 10 consecutive UWorld questions focused solely on this topic. Your goal is that you should get at least 80 or 90% correct on these focused questions.

This is a micro test that's going to validate your entire approach in just one or two days. Now, if you're like most people, you probably won't hit 80% on that focused topic the first time that you do it. If that's true, what this means is that you need to adjust your methods.

There are four critical adjustments if you fail your validation test. First, resources. Are you using the right learning materials for your learning style?

Generally speaking, UWorld and First Aid are good places to start. Second, and more importantly, is comprehension. Are you understanding concepts?

Are you just memorizing facts? If you just reviewed all of the material in that section and you've made flashcards on it and you understand those flash cards, if you're still not getting 80 or 90%, there's a good chance that you just don't understand the facts because you were just memorizing them. Third is application.

Can you apply the knowledge to novel scenarios? USML questions are famous for questions of transfer. Transfer means if I know something in one context, can I transfer or can I use it in another context where the concept is still the same but the details or the facts are going to be different?

And then finally, is it a retention problem? So, are you using space repetition effectively? Granted, if you just studied a single topic like coronary artery disease, retention may not be too much of a problem since you probably won't be forgetting what it is that you just studied if you just studied it the same day or the day before.

Remember, each failed validation test gives you specific feedback on what it is that you need to change. Remember, this is an iterative approach, meaning that you want to constantly be improving this on your way to perfecting your method before you try to scale it up and do a ton more questions. This is the best way that I found to make sure that you don't do thousands of questions only to figure out afterwards that you were doing something wrong and you've got to go back and redo everything.

Now, let's talk about the mindset shift that transforms how you handle challenges in your preparation. Step number eight is to see problems as progress. The difference between students who pass and those who fail often comes down to how they view problem.

Do they see it as a sign of failure or do they see it as evidence of progress? Let's understand why problems are actually good news. When you face a new problem, it's like getting to the next level of a video game.

Video games always get harder, never easier. That's how you know that you're progressing. In the same way, problems aren't signs of inadequacy.

Instead, they're confirmation that you are just advancing and getting better. Remember, each new challenge means that you've mastered everything that came before you, and now you get the privilege of dealing with the next challenge. This perspective completely transformed my frustration that I had whenever I would run into new problems into motivation to solve them.

Just like a video game, the study journey has predictable levels. Level one is really just making sure, do you understand how to learn things in the first place? One of the most common reasons that people are scoring in the 40s or 50s is that they think that they understand concepts, but in reality, they're just memorizing things and so they're not able to actually apply them on enough questions.

People that are in maybe the 50 or 60% level oftentimes are forgetting the things that they're learning. To solve this, you have to make sure that you're using space repetition effectively. Personally, I'm not a huge fan of using a lot of pre-made cards largely because it's a very inefficient way of learning.

Instead, you want to learn how to make cards on your own where you can connect things together and you can use concepts to explain clinical presentations. The next level is really where question interpretation comes into play. to get to the 60s,7s, 80s, or even 90s.

Really, what you need to do is to make sure that you cut down on careless errors. These are situations where you'll know the information, but you're still getting the questions wrong. For this, you want to work especially on question interpretation.

So, context chronology, severity framework, standalone question, rule in and rule out. Recognizing your current level helps you to apply the right solutions. This leads us to step number nine, which is to look beyond symptoms to find the root causes.

One of the most common things that we hear from students is, "I know that I have a problem, but I don't know exactly why it's happening and I don't know how to solve it. " So, for example, they'll say, "I know that I've got a problem cuz I'm working harder than my friends, but I am scoring way below where it is that they are. I've sacrificed a lot of time and I have no life, and my scores are still very, very subpar.

" They're recognizing the symptoms, but they haven't yet figured out the underlying cause. If you want to figure out how to solve a problem, you have to figure out the right diagnosis. So for example, if I've got tuberculosis, I'll have all the signs and symptoms of TB.

I might have a cough. I might have fever. I might have sputum.

However, if I don't know the actual diagnosis, I'll never solve it. So how do we figure out the root causes of our problems? Whenever you identify a symptom, ask yourself why three times.

So for example, I'm not finishing my blocks in time. Well, why? Well, the reason is because I'm getting stuck between two option choices.

Okay. Well, what? Maybe it's cuz I'm not understanding what the question is really asking.

By asking why, why, why, you can get much more specific. And by doing so, it's a lot easier to solve the problem. Note that even after asking why one time and understanding, okay, well, I'm spending too long on hard questions.

I can also just say, okay, well, I'm just going to set a timer for myself and I'm never going to spend more than 2 minutes on any question. As a side note, if you're struggling with timing issues, this is something that you can do that will immediately improve your scores. In a more general sense, you want to keep this attitude of curiosity where you keep digging until you find an actionable root cause to fix.

Doing this will prevent you from only focusing on the symptoms and instead focus you on the underlying disease. Finally, for step 10, let's put it all together in a step-by-step implementation plan. Remember, this isn't theoretical.

This exact approach has turned failing students into comfortable passes consistently. Let me share exactly how to implement everything that we've covered to virtually guarantee you pass step one. Remember, this isn't theoretical.

We've used this exact approach to help students who were previously failing comfortably pass consistently. Week one, you want to just make sure that what you're doing is going to work. For this, you want to identify your specific micro skill weaknesses and gaps in knowledge using error analysis.

A good topic to start with is coronary artery disease. The reason for this is that you don't have to know a lot of other knowledge of other systems in order to understand it. We'll learn all of the relevant information and first aid about this material and make flashcards on it.

When you make the flash cards, make sure that you're making good connections between cards and actually using the flash cards to reinforce fundamental principles. Then do UWorld in five or 10 question increments. Practice the context chronology severity framework and especially standalone questions.

Remember the goal is to get 80 or 90% on 10 consecutive questions. Once you've done this once, ideally within the first week, you can do this for two or even three subtopics. By the third subtopic, try and add time to it.

In week two, try to master an entire system. For example, if I had already mastered three different subtopics in cardiology, then I might do an entire system like all of cardiology. For this, you want to do 10 questions at a time, and you want to get 80% on 20 consecutive questions.

You're going to uncover a lot of subtopic weaknesses. For this, continue to find the relevant first aid page and master the entire page making cards on this before it is that you move on. I know it sounds counterintuitive, but the most consistent finding that we see is that the students that are making cards on the entire first aid page tend to move much faster through the content in large part because they're anticipating the questions that they're going to be missing in the future as opposed to just reacting to the questions when they get them wrong.

Continue to keep a daily log of your improvements and your challenges. An aggressive goal would be to get through all of cardiology by the end of week two, but if it takes you a little bit longer, that's okay. Remember, it's important that you can prove that your studying is working before you then go on and try to do a bunch more questions.

Once you can get 80% on one system, you're going to want to move on to the next system. Typically, a good next system would be something like pulmonology or nefrology because those systems have a lot of connections with the heart, which you would have just learned. So, next, I want to share with you exactly how to implement everything that we've covered to virtually guarantee that you're going to pass your step one.

I've laid this out with five milestones that you're going to want to make sure that you hit. Remember, you want to hit all of these milestones in this order. This is the best way to make sure that you're not going to get to the end of your studying and figure out, "Oh my gosh, this didn't work.

I've got to go back and start all over. " So, milestone one is subtopic mastery. This is going to be untimed.

Your goal is is to get 80% on one subtopic. Remember, I recommend coronary artery disease just to start just because it's a topic that you can learn all the knowledge for in a relatively short period of time. While you're using this, I want you to focus on micro skills and error analysis so that you can build your process.

Once you've done this and gotten 80% on 10 consecutive questions for one subtopic, now you want to do it for more. So, next milestone two is that you want subtopic mastery where it's both timed and repeated. So, you want to get 80% on three or more subtopics.

One of those should be reviewed in less than 48 hours. Now, if you're reviewing takes longer than 48 hours, it's often going to be due to a lack of card creation or poor anticipation of misses. In other words, it happens when people don't learn all of the information in first aid about that topic before they move on to the next subtopic block.

For milestone three, this is system mastery, and this is going to be timed. You want to get 80% on a full system. So, if I've just been doing cardiology subtopics, I want to get 80% on 20 consecutive timed cardiology questions.

This proves that you can apply your approach across a broader domain. And in addition, it also proves that your cards must be working reasonably well since at this point, you're more likely to have forgotten the things that you may have learned. the week before if you didn't use cards correctly.

Milestone four is doing multiple system mastery. This is where you're going to get 80% on three or more full systems. So, if you've studied cardio and then you've done renal and then you've done GI, you want to get 80% on 20 timed questions from all of those systems mixed together.

Milestone 5 is full mixed block mastery. You want to get 80% on fully mixed blocks. Now, this should be 20 or more questions timed.

And this is going to confirm that your skills are actually scaling across content. At this point, if you've hit all the milestones, you should see significant improvements in your NBMES. If you found this helpful, check out my next video, UWorld Complete Guide, the five levels of mastery to 260 plus.

I'll show you the exact UWorld settings for each stage of your journey. From simple five question blocks to mastering mixed 40 question sessions, you'll learn the precise study metrics that make success inevitable, even if you're starting below passing.