No matter how much time you have remaining to prepare for your boards, you must still prioritize certain exam topics over others. This is true because even if you go through ALL the material once or even twice during your board review, there will always remain topics that you’ll perform worse on during your practice tests.
How do you know which topics you’re weaker on as you’re progressing through your studies? If you took the exam previously and failed, you should review your score document to assess your relative performance levels. And if you’re a first-time exam-taker, you ABSOLUTELY should do practice tests periodically throughout your board exam prep.
Using Q Banks to Customize Your Medical Board Exam Prep
Many Q Banks, including all Q Banks from The Pass Machine, allow two modes of study: the Flashcard (or Study) Mode and the Practice Test (or Exam) Mode. In the Flashcard Mode, you read and respond to each question one at a time and review your answer and the included explanation before moving on to the next question. In Practice Test (or Exam) Mode, you choose ‘exam mode’ from the drop-down and then take a full board-reflective practice exam to assess your overall performance and performance on individual topic areas. And you do this while you still have sufficient time in the board review process (prior to your real exam) to strengthen your performance on the weak topics.
When you do this to direct your further study, you should always prioritize the topics that are both “Big and Bad,” that is, topics that account for a large percentage of total exam questions and that you did poorly on. Start with your worst Big and Bad topic. As soon as you deepen your knowledge and improve your practice exam scores on it, move on to the next Big and Bad Topic.
Don’t Aim for Perfection During Board Review: Passing Your Board Exams Is a Numbers Game
The importance of prioritization is that nearly all exam candidates end up running out of preparation time. It is imperative that you leave the lowest value / lowest leverage topics for last because they’re likely to remain untouched. And that’s ok. You live in the real world. You and virtually everyone else are struggling to find the time, energy, and mental focus to prepare for your boards. In my nearly two and a half decades of running board preparation courses, I’ve never had any physician tell me that they ended up studying as much as they hoped to and planned for.
The reason that running out of time for exam prep is usually ok is because passing board exams is a numbers game. On average, on board exams across the different medical specialties, you need to get a score of about 75% or 3 out of 4 questions right to pass. You will – undoubtedly – get many questions wrong, and most of them are likely to be concentrated in a handful of subjects you’re weakest in. Again, that’s ok. But ensure that these handful of weak topics are associated with the fewest exam questions!
Now, it would not necessarily make sense to focus on a big topic vs a small topic (in cases in which your performance was more or less equivalent on both), if the study effort on both was proportional to their impact on your exam score. For example, if you had to spend ‘X’ amount of time studying a small topic for ‘Y’ positive effect on your exam score, and ‘2X’ amount of time
studying a bid topic for ‘2Y’ positive exam effect, then it wouldn’t matter which topics you focused on – all else being equal.
But that’s not how it usually works: the time spent studying small topics during board review usually has less of a positive effect on your exam score than studying big topics. For example, if you again spend ‘X’ amount of time on a small topic for ‘Y’ effect, then you might only need to spend ‘1.5X’ amount of time to achieve a ‘2Y’ positive exam effect.
It is not unusual that preparing for a subject that accounts for perhaps 3-4% of the exam may take nearly as much prep time prepping on a topic that accounts for 10-12% of the entire exam!
Summary: Focus on the Big and Bad topics because they better leverage your study investment in terms of effect on your exam score.
Get Started with High-Yield Board Exam Prep Today
Check out our entire catalogue of board courses here. They all come with a “better than money back” guarantee because they’re that good! So, don’t fret, waste time, or procrastinate. Instead, start prepping today with The Pass Machine!
Board Review: Frequently Asked Questions
How do I prepare for medical board exam questions?
To prepare effectively for medical board exam questions, you need a targeted and strategic approach – not just more study time, but smarter study time. The key is to identify and prioritize “Big and Bad” topics – those that (1) account for a large percentage of questions on the exam and (2) are areas where your practice test performance is weakest.
Here’s how to get started:
- Use Q Banks Wisely: Platforms like The Pass Machine offer two modes: Flashcard Mode (for review) and Practice Test Mode (to simulate exam conditions). Start with practice exams to assess your strengths and weaknesses.
- Focus on High-Yield Topics: Allocate a majority of your study time to topics that carry the most weight on the exam and that you struggle with the most.
- Track Progress with Metrics: Regularly take full-length practice exams to monitor improvement and redirect study time to areas still underperforming.
- Don’t Aim for 100%: Most board exams require a passing score of around 75%. You don’t need to master everything—just the most impactful areas.
This targeted strategy ensures you maximize your study investment and improve your chances of passing the boards.
What are the medical board exam scores that lead to passing the exam?
While medical board exam pass rates vary by specialty and certifying board, most U.S. medical board exams have passing thresholds around 70–75% correct answers. The exact pass rate may shift slightly year to year because each exam version is normed to its other versions.
The bottom line: Board exams are designed to be challenging but passable with the right preparation strategy, especially one focusing on big, high-yield topics.
Who fails their board exams?
If you’re wondering, “Who fails their board exams?” The answer is complicated – board exam failure can happen for various reasons. However, there are common patterns among those who struggle:
- Lack of Prioritization: Candidates who try to study everything equally during the board review process often run out of time and neglect high-impact topics.
- Infrequent Self-Assessment: Without regular practice tests, it’s difficult to know which subjects need more attention.
- Inefficient Study Habits: Spending too much time on low-yield or familiar topics instead of tackling weak areas that are highly represented on the exam.
- Time Constraints: Many candidates are practicing physicians balancing work, family, and study. It’s common to run out of time or energy.
As the blog points out, the goal isn’t perfection. It’s about being smart with limited time – prioritizing the most testable, high-impact content to ensure you’re not missing easy points due to inefficient prep. Check out our entire catalogue of board courses to start your board review and ensure you aren’t someone who fails their boards.
American Physician
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