Doctor of Medicine (M.D.)
Tbilisi State Medical University
Tips for Test Day From an International Medical Graduate
Breaking through some of the myths surrounding Step 1 can be a challenge on its own. As a medical student outside the United States, also called an “IMG,” the only things I heard about the exam was how notoriously difficult it was and how others sacrificed their social lives preparing for it. After a long journey, I finally arrived to test day myself, only to find out that my fear and anxiety was unwarranted. Here are a few tips to make your own USMLE® step 1 test day experience as smooth as possible.
Throw Out the General Tips and Focus on Yourself
Countless guides out there will tell you to either study or not study the day before the exam, to get more or less sleep, or to eat and drink this or that food. While they undoubtedly try to help from their own perspective, most of them don’t take into account you as a person. The key message here is that you want to be focused and ready for exam day, and shaking in fear the previous day is not going to help! You are an individual and the way you deal with stress can be enormously different from those around you. You’re going to be at least slightly anxious no matter what you do, and while meditation or sleep can be beneficial to some, it might not work for you.
I hear most of you asking now: “What can I do about all of that anxiety then?” I’ll answer that simply with another question: “What do you enjoy doing?” Some people relax while listening to music, others do so while exercising or cooking. Think about the things you like to do to relax, and do them. You’ll find that far more effective than following the example of others.
Personally, I was shaking in my boots and trying to review everything possible. Did this help me? Not at all! None of the topics I tried to review stuck to me when I was in that fearful state of mind. I realized this quite late; it was a week before test day, and all of the anxiety and overexertion had finally caught up to me. I felt exhausted and unhappy. What was my way out? I started taking 2–3 hour breaks each day just to relax and listen to my favorite music.
One important tip I’d give just about everyone in the medical profession is this: break time is break time!
If you’re still thinking about work while you’re resting, you’ll face severe burnout… so make sure you focus on relaxing.
Make Sure There Are No Surprises
Getting a surprise gift on your birthday can be a dream come true, but getting a surprise on test day can be a nightmare. Making sure you’re comfortable with the system is absolutely essential. You can do this by completing a self-assessment provided by NBME® or going through a practice test or self-assessment in Lecturio’s Qbank. Either way, the goal is twofold – making sure that you’re comfortable with the system and building stamina. The USMLE® Step 1 is an 8-hour exam, and while you do get time for breaks, you need to adapt yourself to be able to answer the questions consistently while dealing with fatigue over the course of the day. When I first began studying for the USMLE®, I used to have trouble finishing even a single NBME® block… But a few weeks before test day, I went through 7 blocks of Uworld without breaking a sweat! I started off by gradually increasing the amount of questions I did each day to build my stamina. When I came out of the exam room, I was simply amazed! I didn’t feel tired at all after 8 hours of testing.
Have the Items You Need
What to bring to test day is a commonly asked question, with a variety of answers. The rules surrounding the exam are quite strict. Of course, you want to make sure to bring your approved form of identification and your scheduling permit. But what else is allowed? I have problems working in a noisy environment, and while the staff do their best to ensure a quiet environment, the occasional case of people coughing, sneezing or muttering to themselves can be a distraction. Luckily, you’re allowed to bring a pair of soft earbuds to cancel out the noise; just make sure take them off during the questions requiring you to listen for heart sounds!
Pro tip: Check the USMLE booklet and at your prometric testing center to know what you can/can’t bring to the exam!
I had the unfortunate privilege of catching a cold just before my exam day. Now, as you might guess, I had some trouble breathing through my nose. You’re allowed to bring certain medications into the exam with you as long as they’re properly inspected by the staff. To this day, I believe those decongesting nasal drops saved me from losing a good share of my score. Most Prometric centers are quite accommodating when it comes to your health needs. Just make sure you run through what’s allowed into the test center with them beforehand.
Food Will Help You Get Through the Exam
There are very few guarantees when it comes to taking the Steps. But one of them is that you’re bound to get hungry during those 8 hours. Bringing the correct food with you on test day can be the difference between focusing clearly on the questions or your growling stomach. I can’t say specifically what you should bring, as nutritional requirements and tastes differ significantly, so bring something you actually like.
In my experience, using at least 15 minutes from your break time to have a proper lunch worked wonders for my mental state. I’d suggest staying away from sugary foods, as they’ll just give you a short rush of energy and you’ll be exhausted again in a few minutes. Stay clear of items which can spoil – the exam centers don’t provide refrigerators for you to store food. Foods such as individually-wrapped or vacuum-sealed sandwiches containing adequate amounts of protein, carbohydrates, and fats are optimal.
I’m a foodie. I like cooking and I like eating even more, so I needed something palatable to eat, otherwise I would have been quite miserable. I made a couple of salami sandwiches with a bunch of lettuce, arugula, and Swiss cheese. Coupled with coffee, it made for a great lunch and kept me going for the remaining 4 hours. Also, I would like to use this occasion to thank the first person in history who decided to grind up and brew roasted coffee beans – they are my hero. As medical students, we always hear how important it is to have proper nutrition, and as doctors we’ll need to counsel our patients about their diets. I’d challenge you all to practice what you’ll be preaching!
Take Pride in Yourself – You’ve Made It This Far!
One of the reasons I decided to become a doctor, aside from wanting to care for people, was seeing the respectable role they have in society. Being a physician is a sort of badge of honor that you carry, and people tend to admire you for it. One thing that we tend to forget though is to give ourselves credit. I know I had that problem! No matter how hard I worked, it never improved my self-confidence. Looking back at it now, that probably lost me a number of opportunities. But not anymore!
You’ve made it to test day. You have studied for hours on end and dedicated yourself to acing this exam. Take a minute and take pride in your achievements. No matter what your score is, you’re on the path to being a doctor. You will always be a person dedicated to caring for others, a truly special and rare individual. Pump up your confidence, have faith in yourself, and look at the exam head-on, without fear or anxiety. When you’re ready to face the challenge, you’ll find that the USMLE® Step 1 exam is exactly that – just another exam.