How to crush USMLE Step 1 on game-day?

This month, I took the USMLE Step 1 examination, and while I have things fresh in my mind, I’ve decided to share my experience along with some helpful tips. Hopefully this is helpful to someone preparing for the exam.  Just a disclaimer, I’m by no means an expert at the USMLE and every exam has inherent variability.

WHAT DID I DO THE DAY BEFORE EXAM DAY?

Take it easy the day before. If you want to review, maybe do some light content reviews. Realistically, you won’t be able to learn anything new the day before the exam, so don’t stress too much about things you think you don’t know. There is way too much content on the exam for you to know everything. Do something to calm your nerves. I definitely recommend going out and being active. I went for a run in the afternoon. After that, I was pretty tired and it helped me fall asleep later that night.

SLEEP LEADING UP TO THE EXAM

Sleep is a huge factor for long exams like this. I started going to sleep early a few days before the exam and making sure I was getting eight hours of sleep each night. The night of the exam I took a melatonin and knocked out almost right away. If you’ve had trouble waking up in the past, I would maybe avoid taking anything like that. In my opinion, sometimes it’s the sleep leading up to the test that’s sometimes more important than the night of. Everyone has trouble falling asleep the night before a big exam, so it’s completely normal if you can’t get a good night’s sleep the night before. Say you do end up running a bit late, it’s not the end of the world. My testing center was very accommodating. However, if you’re not feeling well, don’t risk it – reschedule it for a future date.

NUTRITION

One of the things I can’t stress enough is food. However, not all foods are good exam day foods. The day before my exam, I went to Wholefoods and stocked up on a bunch of keto protein bars and nut bars. I prioritized low carbohydrate and high fat snacks. Why? Foods with high carbohydrates can cause a large spike in blood glucose, which is followed by a large insulin spike. The last thing I need is to have a sugar crash during the exam. Fat digestion results in a more gradual and moderate glucose elevation that can fuel you for longer periods. Even if I was having carbohydrates, I tried to prioritize complex carbohydrates. Complex carbohydrates like oats take a longer time to break down unlike simple carbohydrates like cereal which are broken down quickly and deliver a rapid spike in glucose. For breakfast, I kept it simple with some eggs, some steel-cut oats, and a little bit of coffee (⅓ of my usual). For my lunch break, which took about 20 minutes, I ate some overnight oats loaded with protein powder, walnuts, bananas, and peanut butter. Throughout the exam, my energy level was consistent and I never actively felt tired. I think this was a game-changer for me and definitely recommend it to others.

BREAKS

Each block of the USMLE Step 1 consists of 40 questions and a maximum of 60 minutes is allotted for each of them. There’s also a 60 minute break. This all adds up to 8 hours of exam time. A cool thing that the USMLE does is that anytime you finish a question block section early that time gets added to your break time. You can elect to take breaks at any point in between the question blocks. After every section of the test, I would strongly recommend taking a break in order to refresh your memory and mental stamina. I alternated between short 3-5 minute breaks where I would sit at my desk and longer 8-10 minute breaks where I would take a walk outside. Walk outside? Yes! You’re allowed to walk around and even use your phone during the breaks. So, walk outside, look at the sun, and stretch! 

EXAM QUESTIONS AND GAMETIME ADVICE

What did I think about the style of the exam questions? I thought these questions were very similar to the new F120 question prompts, but with one caveat. I felt as if the answer choices were most representative of those given by the NBME Step 1 forms, so shorter and straight-forward answer choices. If you haven’t taken the new F120 practice questions, a close runner up would be UWorld with simpler answer choices. In terms of the difficulty of the questions themselves, I felt as if they were similar to that of a NBME. So, I definitely recommend taking the most recent NBME forms to get a feel for the difficulty. Also, my examination seemed very pathology heavy on especially buzz-wordy topics. Make sure you know what a bird’s-beak appearance is on manometry!

Did you know that roughly 25% or around 70 to 80 questions per test are experimental questions? These are non-scored exam questions. During my exam, I definitely was able to pick out some questions that felt different from other prompts. They were either much more lengthy than other questions or asked very non-specific things. Every time I was stuck on a question, I didn’t let it dampen my confidence. I tried my best and told myself that even if I did get it wrong it’s probably an experimental question. The USMLE is a huge mental game. You don’t want to feel defeated. If you feel like you’re not doing well, it’s going to impact your performance. As of date, to pass Step 1, you need to get around 60% correct. However, since the exams vary in difficulty, each exam is scaled accordingly. So, just have in the back of your mind that this might have just been a harder test. After the test, give yourself some credit for taking a long and hard seven hour exam. Don’t persist over questions you think you might have gotten wrong. Leave those thoughts behind at the testing center and go enjoy the rest of your day. 

WHAT I WISH I DID

What are some other things I wish I knew or did before exam day? The USMLE allows students to bring an unmarked water bottle with them into the testing room. Some people brought regular plastic Poland Spring water bottles and simply tore off the labels from the bottles. If I could go back in time, I’d definitely bring a plastic bottle with him into the exam room. Most if not all testing sites have places where you could refill your water bottle. Hydration is just as important as keeping food in your system. Another thing I wish I did before testing was visiting the actual testing site. If you have time and it’s close by, it wouldn’t hurt to check it out. When I went to my site, I had trouble discerning which one of the buildings in this huge corporate park was my actual testing site. Figuring out where to park was another headache. Save yourself some trouble on test day and go check out the site or just plan to get there early the next morning. On days that I test, I always wake up early and go in with the mindset that there could be something that turns my ten minute commute into a thirty minute commute. 

BOTTOM LINE

The USMLE is tough, but I wouldn’t say it’s much harder than an NBME exam. Take it easy the day before. Pack your snacks and lunch the night before. Arrive early to your testing site. Most importantly of all, don’t dwell on the questions after the exam!