Preparing for the USMLE: Things I Regret Not Doing

The USMLE (United States Medical Licensing Examination) is more than just a test—it’s a rite of passage, a mental marathon, and for many international medical graduates (IMGs), a defining moment in their careers. Like many before me, I dove into this process with ambition, Google tabs open, and a mountain of prep books by my side. But if I could go back in time, there are so many things I wish someone had told me. Things that would have saved me time, mental energy, and perhaps even boosted my score.

This isn’t your typical “how to” article. It’s a brutally honest, experience-based survival guide—packed with practical insights, mistakes, and lessons I wish I had learned before sitting for USMLE Step 1, Step 2 CK, and even Step 3.

Table of Contents

1. What is the USMLE? A Quick Recap
2. The Dangerous Myth of Perfection
3. Study Resources I Overused (and Underused)
4. UWorld Isn’t Just a Question Bank—It’s a Textbook
5. First Aid: Not the Bible, but Close
6. What No One Told Me About NBME Practice Exams
7. The Timeline Trap: When to Start and Stop Studying
8. Mental Health and Burnout: My Hidden Struggle
9. IMG Challenges I Didn’t Anticipate
10. Test Day: What Actually Happens
11. My Advice to Future Test-Takers
12. Final Reflections: Hindsight Wisdom

1. What is the USMLE? A Quick Recap

The USMLE is a three-step exam required for medical licensure in the U.S. Each part evaluates a different aspect of your readiness to practice:

• Step 1: Focuses on basic sciences (physiology, pathology, biochemistry, etc.)
• Step 2 CK: Assesses clinical knowledge (diagnosis, management, patient care)
• Step 3: Evaluates your ability to apply clinical knowledge in real-world scenarios (often taken during or after residency)

The stakes are high—especially for IMGs. Your scores influence residency interviews, competitiveness, and even visa options.

2. The Dangerous Myth of Perfection

One of the most toxic beliefs I carried was the idea that I needed a perfect score. Forums, Reddit threads, and IMG Facebook groups were filled with stories of 260+ scorers getting into top programs. I obsessed over these numbers and put myself under enormous pressure.

What I didn’t understand is this: A strong, balanced application is more powerful than just a high score. Clinical experience, research, recommendation letters, and interview skills all matter.

What I wish I knew: Focus on consistent improvement, not perfection.

3. Study Resources I Overused (and Underused)

I spent too much time hoarding resources—AMBOSS, BRS, Boards & Beyond, Pathoma, Anki decks, etc.—but didn’t master any of them. I thought more resources meant better preparation. It didn’t.

What worked best:

• UWorld (twice, timed + tutor mode)
• First Aid Step 1 (cover to cover)
• Pathoma + Sketchy (selectively)
• Anki (light but consistent usage)

What I wish I knew: Less is more. Master 2–3 resources instead of skimming 7.

4. UWorld Isn’t Just a Question Bank—It’s a Textbook

In my early days, I treated UWorld as just practice. I answered questions, got some right, some wrong, moved on. Big mistake.

UWorld is not just for testing—it’s for learning. The explanations, especially for wrong answers, are gold. I started printing out my incorrect questions and annotating them in my First Aid book. That’s when my score actually started improving.

What I wish I knew: Read every explanation, not just the correct one.

5. First Aid: Not the Bible, but Close

Everyone says “First Aid is the Bible.” Yes and no.

It’s an essential roadmap, but not enough on its own. It doesn’t teach—it summarizes. Use it after you’ve built foundational knowledge. I initially memorized lists without understanding mechanisms. That backfired on NBME questions that asked why, not just what.

What I wish I knew: Pair First Aid with active learning, not passive memorization.

6. What No One Told Me About NBME Practice Exams

I ignored the NBME practice exams for too long. I thought they were expensive and not worth it. That was a mistake.

These practice tests are the closest you’ll get to the real exam—in terms of question style, pacing, and difficulty. Doing them helped me pinpoint my weaknesses and mentally simulate test day.

What I wish I knew: Take at least 2–3 NBMEs before the actual exam.

7. The Timeline Trap: When to Start and Stop Studying

I thought 6 months was enough. Then I thought 8 months would be better. Then I didn’t know when to stop.

There’s a danger in studying too long—you burn out. There’s also danger in rushing.

What worked best:

• 2–3 months of strong foundation review
• 2 months of high-yield focus and UWorld review
• 2–4 weeks of full-day mock simulations and rest days

What I wish I knew: Quality beats quantity. Set a clear end date.

8. Mental Health and Burnout: My Hidden Struggle

I didn’t expect the loneliness. Or the stress. Or the identity crisis when I failed a block.

As an IMG, I felt isolated—studying in a foreign language, away from family, with my future hanging on one number.

What helped:

• Study groups (online or offline)
• Breaks every day (walks, journaling, prayer)
• Talking to other USMLE takers

What I wish I knew: You can’t pour from an empty cup. Prioritize your mind as much as your memory.

9. IMG Challenges I Didn’t Anticipate

I underestimated how tough it would be to balance visas, ECFMG certification, transcript verification, and US clinical experience (USCE). While I was buried in biochemistry, I neglected my CV. That hurt my application.

What I wish I knew: Start organizing your documents early and apply for electives even during prep.

10. Test Day: What Actually Happens

Here’s what they don’t tell you:

• The prometric center feels like airport security.
• You’ll be nervous no matter how prepared you are.
• The interface is clunky. Practice using the same format.
• The breaks are short, and you must plan hydration and food in advance.

What I wish I knew: Bring protein bars, memorize your timing strategy, and expect the unexpected.

11. My Advice to Future Test-Takers

• Don’t study in isolation. Find a community.
• Treat UWorld like a course. Not a quiz.
• Practice full-length mocks. Train your stamina.
• Know your “why.” Scores alone won’t keep you going.
• Balance is not optional. Your mental health is part of your score.

12. Final Reflections: Hindsight Wisdom

The USMLE is hard—but it’s not unbeatable. What makes it harder is the fear, the confusion, and the unrealistic pressure we put on ourselves.

I passed. I matched. But more importantly, I grew. I became more resilient, more disciplined, and more compassionate—toward myself and others.

If you’re reading this before your exam, know this: You’re not behind. You’re not alone. And you’re more capable than you think.