USMLE/COMLEX Life Savers 2: The Law of Diminishing Returns

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Via Ryan McGilchrist @ flickr

Patrick C. Beeman, MD


Last time I discussed the importance of practice questions for your USMLE, COMLEX (really any type of “board” exam). That makes sense, right? But I also discovered a boards success paradox as well: the “law of diminishing returns.” In the economy of medical school, this says (and to be fair, I totally made this law up) that for each person there is a certain peak amount of time after which adding more study time isn’t going to raise their test score very much. Discovering this law is about accepting one’s limitations. It’s about humility. It’s about that ancient Delphic oracle’s advice to Socrates: Know Thyself ( see my previous take on this subject here).


I found out that I could study for 20 hours for a high pass. Or 25, or 30… or even 40. However, an honors was about 50 hours worth of study time. The conclusion? If I can’t give 50 hours to get the high score, why spend 25 or 30 when 20 will suffice? It was kind of liberating. I made a pact with myself to stop any sort of studying by 6:30 pm during my second year in order to spend time with my family and take care of other basic needs. The result of burning my textbooks (after 6:30 pm of course) and using only the review books, was that second year was soooooooo much easier. Even enjoyable. I finished that year with all honors.


Then I took Step 1. As I mentioned before, once I got my score I realized questions were the key that unlocked the door of boards success. Mind you, it took a whole “nother” year for me to realize this. If I had known this at the beginning of second year, I would probably have just done the questions in the back of those books, largely ignoring the text at the beginning of the chapters. If only. I might have been able to reunite with my XBOX. Alas, sometimes reminiscing on the past hurts.


Another disclaimer: As you’ve gathered, I one hundred percent believe that your success on medical school/residency tests is directly proportional to the number and quality of the questions you do in preparation. I’m damn near fanatical about it, in fact. Nevertheless, residency will teach you very quickly that questions aren’t the only ingredient to competence in your field. Yes they can train you to apply information to clinical situations. But those situations—the question stems—are artificial. When was the last time you saw an H&P that was only six lines long? You know, the ones you put down that leave you with more questions than answers? Exactly. You haven’t.


Because if you’re reading this, you’re a medical student or a resident, and you’re the one writing the H&Ps. The three line “attending H&P”, so full of authority, so devoid of information, value, punctuation or anything resembling grammar, is a dim memory (or a personal goal, as the case may be) of reading the consult note of some service involved in the care of a mutual patient when you were on a community hospital rotation with a preceptor kind enough to abuse–I mean teach–a medical student for a month or so. Full disclosure: I am an attending now. And my H&Ps look like this: Case discussed with the resident. Agree with A/P (a big thanks to my residents, by the way).


No. Questions aren’t the whole story for medical education. You do need primary literature and textbooks to be competent, i.e. for real life. You just don’t need them for your tests (the part of your life that matters for getting to the next step in your career).


Thanks for reading, and feel free to leave a comment or question. We’d really like to know what sort of content you want to see and how we can help you. I really appreciate your time. I know it’s precious. Now go do some questions. 😉