Why Memorizing Review Books Is Not What 260+ Scorers Actually Do

The idea that “people who score 260+ basically memorize First Aid cover to cover” is a fantasy that refuses to die.

High scorers are not human photocopiers. They are pattern recognizers. And the way they study looks very different from the mythology you hear on Reddit and in panicked group chats.

Let me be blunt: if your main Step/Level prep strategy is “memorize review books,” you are capping your score and wasting your time.

Here’s what the data, the test design, and real 260+ scorers actually point to.

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The Myth: “Top Scorers Just Memorize the Review Books”

You’ve heard some version of this:

• “My friend’s friend got a 265. He just memorized First Aid three times.”
• “All you need is UWorld + memorize Pathoma + First Aid.”
• “If you really know every line of First Aid, you’ll crush it.”

No. You’ll become a decent trivia machine with a mediocre test score ceiling.

The modern exams (USMLE/COMLEX) are not built to reward pure fact-recitation. They’re built to:

• Punish shallow recall out of context
• Reward flexible application of concepts
• Mix basic science with clinical reasoning under time pressure

That’s not me speculating. That’s literally how NBME and NBOME describe their own exams.

What the test-makers actually say

USMLE’s own materials emphasize:

• “Application of foundational science concepts”
• “Integration across disciplines”
• “Multi-step reasoning”

None of that screams “Did you memorize the third bullet under von Gierke disease?”

If “memorize the book” worked reliably, you’d see one very obvious pattern: every student who grinds First Aid line-by-line would score 250+. That’s not what happens. What you actually see is:

• The “memorizers” cluster in the mid-range
• The top scorers overwhelmingly talk about questions, errors, and active learning, with review books in a supporting role

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What 260+ Scorers Actually Do (And It’s Not Book Memorization)

High scorers do use review books. They just don’t worship them. They build a system around how the exam really works.

1. They treat Qbanks as the core, not the accessory

Ask 10 genuine 260+ scorers how they prepped. You’ll hear the same phrases over and over:

• “I did UWorld in tutor/timed and reviewed every question deeply.”
• “I cared more about understanding explanations than my percent correct.”
• “My score jumped when I started tracking and fixing my mistakes.”

They don’t just “get through” UWorld. They mine it.

Realistic Time Allocation of High Scorers

Category	Value
Qbanks & Review	45
Spaced Repetition ([Anki](https://residencyadvisor.com/resources/exam-prep-resources/myth-more-anki-decks-equal-better-recall-on-test-day))	25
Videos/References	20
Review Books Memorization	10

Notice that last slice. Memorizing review books is a minority activity, not the main event.

What they actually do with Qbanks:

• Do questions in exam-like blocks (timed, mixed) when close to test
• Read explanations for right and wrong answers
• Build or add cards for concepts they missed or guessed
• Look up confusing topics in a reference (e.g., UpToDate/AMBOSS, B&B, a focused chapter)
• Re-encounter those concepts again later in different questions

That loop — question → explanation → concept → spaced reinforcement → new questions — is where 260+ scores are built.

Not in memorizing every line of a chapter on lysosomal storage diseases.

2. They build schemas, not scripts

Low scorers have “scripts”:

• “Cushing = buffalo hump, striae, hypertension, hyperglycemia.”
• “Nephrotic = edema, proteinuria, hyperlipidemia.”

High scorers build schemas. They understand:

• Why excess cortisol causes each of those Cushing features
• How protein loss leads to edema and hypercoagulability in nephrotic syndrome
• How similar pathologies can present differently (e.g., minimal change vs FSGS vs membranous)

That schema lets them handle weird versions of common topics — which is exactly what the exam throws at you.

Review books give you lists. High scorers mentally reorganize those lists into:

• Pathophysiology chains
• Pattern-recognition clusters
• “If the question stem gives you X, you should think about Y and Z” branches

That reorganization doesn’t come from passive rereading. It comes from being repeatedly forced (via questions) to apply the material.

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The Cognitive Science Problem With “Memorize the Book”

You can fight with cognitive science if you want. You will lose.

Decades of data on learning tell you:

• Passive rereading = low retention, low transfer
• Active retrieval (recalling without the answer in front of you) = high retention
• Spaced repetition (spread over time) beats cramming
• Interleaving (mixing topics) beats block-by-block “system” study for long-term, flexible knowledge

Review book memorization is almost always:

• Passive (staring at pages or highlighting)
• Massed (hours on one topic in one sitting)
• Poorly tested (little retrieval, minimal self-testing beyond “yeah that looks familiar”)

This is the exact opposite of what improves performance on a high-level exam.

Why top scorers love Anki or some spaced system

Do all 260+ scorers use Anki? No.

But almost all of them:

• Use some form of active recall
• Revisit hard concepts multiple times across weeks
• Mix in old topics while learning new ones

For many, that’s Anki. For others, it’s self-written flashcards, question tags, or repeated Qbank passes with targeted review. The method can vary. The principle does not: they do not rely on “I read that chapter three times, so I must know it.”

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Where Review Books Actually Fit (When Used Correctly)

Review books are tools. The problem is when people use a hammer to stir soup.

Here’s how high scorers typically use them — from talking to actual people with 260+ and watching what they actually did, not what they posted in flexed-up study schedules.

1. As an orientation map, not scripture

First Aid, Pathoma, BRS, whatever your flavor: they give you the scope of tested topics.

High scorers use them to:

• Make sure they’re not missing big content areas
• Get a quick scaffold before deeper learning
• Clarify what’s low vs high yield

But they don’t sit there memorizing every single adverse effect listed for every single drug. Because the opportunity cost is brutal.

2. As a reference, post-question

The most efficient way to use a review book: after you just got burned on a question.

• You miss a question on restrictive lung disease physiology
• You go to your review resource, read the relevant section with that question in mind
• You update or make cards on the key relationships (FVC, FEV1, TLC patterns, causes)
• You’re now much more likely to recognize and apply those concepts next time

That’s very different from, “On Monday, I read all of pulmonary from First Aid.”

3. As a compressed checklist near the end

In the last 2–3 weeks before the exam, high scorers often scan review books.

Not to “memorize everything,” but to:

• Re-anchor themselves to what’s fair game
• Catch areas they’ve subconsciously neglected
• Trigger recall of things they’ve already learned elsewhere

Think of review books as a dense checklist and memory jogger, not the main engine.

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What Top Scorers Actually Spend Their Time On

Let’s quantify this a bit. Obviously this varies by person, but across many strong scorers, the pattern is remarkably consistent.

Activity Type	Approx % of Study Time
Qbanks (doing + deep review)	40–50%
Spaced repetition / flashcards	20–30%
Videos / in-depth references	15–25%
Review books (reading/memorize)	5–15%

Notice what’s missing: “Four passes of First Aid” as a main line item.

Review books are the garnish. Not the dish.

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Why The Memorization Myth Survives

So why do people keep repeating “they just memorized First Aid”?

A few reasons.

1. Survivorship bias and revisionist history

High scorers themselves often misremember what mattered most.

I’ve heard this countless times:

• M2: “That guy who got a 265 said he just read First Aid three times!”
• Me, later, talking directly to that “guy”: he actually did UWorld twice, 10k+ Anki cards, a ton of NBME practice, and skimmed First Aid as a side activity.

But “I just read First Aid” sounds cooler, simpler, more marketable. So the story mutates.

2. It’s easier to sell “just memorize this”

Certain YouTube channels, tutors, and “study plans” conveniently overemphasize a single book or set of notes. Why? It’s easy to package. Easy to brand. Easy to sell the fantasy of “follow this and you’re guaranteed.”

Nuanced, evidence-based advice like “you need a Qbank-heavy, feedback-driven, error-focused system” doesn’t sell as well because it requires actual thinking and ongoing adjustment.

3. Students want control, and memorization feels controllable

When you’re anxious and the stakes are high, objective-looking tasks feel safe:

• “Read 30 pages today.”
• “Finish Pathoma Chapter 5.”
• “Do First Aid cardio twice this week.”

You can check those off. It feels like progress.

But the exam doesn’t care how many pages you’ve touched. It only cares what you can retrieve, understand, and apply in 90 seconds under pressure.

Questions + active recall are ugly. They expose ignorance. They hurt your ego. That’s why high scorers lean into them. While average scorers hide in their book caves.

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A More Realistic 260+ Strategy (Without Worshipping Any Book)

Let me sketch how a top-shelf, evidence-aligned plan actually looks.

Foundation Phase (pre-dedicated)

• Use your actual course material and a decent video/review resource to understand core concepts.
• Start light but consistent spaced repetition (e.g., 50–150 cards/day) on high-yield facts and mechanisms.
• Use a smaller Qbank or subject-specific questions after blocks to test understanding.

Review books in this phase: quick scans before or after learning a system, not word-for-word memorization.

Dedicated Phase

Daily ingredients:

• 40–80 Qbank questions (timed, mixed, exam-like).
• Deep review of each block: why each wrong option is wrong, why right is right, what general rule you can pull out.
• 1–2 focused video/review segments for topics you consistently miss.
• A set amount of spaced repetition (new and review cards), drawn from your real errors.

Review books: maybe 30–60 minutes/day total, used surgically for:

• Quick clarification after confusing Qs
• Rapid scanning of a system you have not seen in a while
• End-of-day or end-of-week “anchor” on big-picture stuff

Final 2–3 Weeks

Shift toward:

• NBME/COMSAE/full-length practice exams under real conditions
• Targeted repair of weak areas exposed by practice tests
• Higher emphasis on re-seeing things you’ve already missed before (via cards and old Qs)

Review books: high-level sweeps, focusing on:

• Tables and summary diagrams
• Common path buzzwords simply to avoid “I recognize this but can’t name it” moments
• Cross-checking that there aren’t entire topics you’ve inexplicably ignored

At no point is “memorize this book cover to cover” your core strategy.

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Visual: How The Process Actually Flows

High-Yield Exam Prep Workflow

Step	Description
Step 1	Do Qbank Block
Step 2	Review Explanations Deeply
Step 3	Look Up in Video/Ref/Book
Step 4	Create/Update Flashcards
Step 5	Extract General Rule
Step 6	Spaced Repetition Over Days/Weeks
Step 7	Repeat With New Qbank Blocks
Step 8	Periodic NBME/Full Exam
Step 9	Adjust Focus Areas
Step 10	Concept Weak?

Notice something? The review book is one small step in the loop (D). Not the whole loop.

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FAQs

1. “So should I skip review books entirely?”

No. Skipping them completely is dumb. What I’m saying is: stop centering your entire strategy on memorizing them.

Use them as:

• A scope map of what’s fair game
• A quick clarification tool after questions
• A compact checklist during the final few weeks

If you find yourself spending >20–25% of your total dedicated time just reading review books, you’re almost certainly overdoing it and under-training the skills that actually raise your score.

2. “But I know someone who really did just memorize First Aid and got a 260+.”

Maybe. Or maybe they:

• Had phenomenal lectures and foundations from MS1–2
• Did tons of questions without bragging about it
• Have an unusually good memory and test-taking instincts

Anecdotes don’t beat statistics or test design. If your plan hinges on “I’ll be the exception,” it’s a bad plan. High scorers overwhelmingly have question- and feedback-heavy prep. That’s where you should bet.

3. “Can I hit 250+ if I already wasted time memorizing books?”

Yes — if you pivot now.

Your memorization isn’t totally wasted; you’ve at least seen the material. But from this point forward:

• Push Qbanks to the center of your day
• Turn mistakes into cards or notes that you retest
• Use your review book only as a rapid reference and checklist, not a daily grind

The sooner you stop trying to be a walking PDF and start training like an examinee, the sooner your score trajectory changes.

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Key points:

1. Top scorers don’t memorize review books; they build concepts, patterns, and decision-making skills through questions and active recall.
2. Review books are tools for orientation and clarification, not the backbone of an effective study plan.
3. If your prep is page-count driven instead of question-, error-, and feedback-driven, you’re optimizing for comfort, not for a 260+.