Exam Taking Tips for USMLE Step 1

by Pravin Shukle, MD

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    00:00 Let's take a look on my computer at how the exams are set up. So if you take a look at this image here on my computer, you can see that the exams are big big rooms, maybe a thousand people writing an exam at the same time and the people that are beside you may not be writing the same exam as you. They maybe writing say an Accounting exam or an Engineering exam or a Nursing exam or maybe they're writing a Foreign Service entry exam. The point is is that the people around you aren't writing the same exams and the invigilators that are walking around have absolutely no idea about the content of your exam. Something that's really important to know is that you can't be late. There is no exceptions. If you are late, you're going to have to wait until next year. I saw this happen with my own eyes about 4 years ago when I was writing a re-certification exam for Echocardiography. A person showed up late, he was at the front door and we all watched this poor fellow be sent away and he'd have to wait until next year to write his exams. Now, bathroom breaks are often not allowed within each exam unit. This rule sometimes changes with the test center but in general consider that a rule and be prepared for that. Now the exams are often 8 hours long. So they're broken up into 7 one-hour units and then there are breaks in between each of the unit with a slightly longer break at lunch. The Canadian exams are 12 hours long and they're broken up into 4 units with 196 questions in the morning session and sure to answer essays questions in the afternoon.

    01:40 So the exams are long so be prepared for the long run. Now, each unit of the USMLE Step 1 consists of about 40-50 questions. You can go back and forth when you're within that unit but once the unit is over, you can't go back to that unit. All of the questions are on a computer screen in front of you. You will have a workbook and sometimes a scratch pad or a calculation pad beside you. If you have a medical condition that requires medication or pills, you cannot keep them in the bottle. They are often kept on the corner of the table. So what I did is I would just tear off a piece of the paper from my scratch pad, put it on the corner of the desk and then put my medications on top of the desk. Insulin pens, EpiPen, those are usually kept on the corner of the table as well and they should be unwrapped. Now, there's more information on the website so go to for the United States Exams or for the Canadian Exams. If you have a cast or some kind of a prosthetic brace or something like that from an athletic injury that happens just a few weeks before hand make sure you go on to the website and take a look at the guidelines because they will actually search the cast. There are also special dispensation for certain medical reasons or disabilities like wheelchairs, etc. Now, the night before you arrive, you will probably be staying in a hotel. Most people who are writing exams are writing exams in different cities. Watch out for those morning in-room pre-order breakfasts. So when I wrote my Echo re-certification exam 3 years ago, there is about a thousand of us writing the Echo exam and then there was probably another 2000 or 3000 people who are writing other exams like Management. The problem was that the pre-ordered breakfast. I ordered my breakfast for 6 a.m. and the breakfast didn't come until 9 a.m. because the hotels are so overwhelmed. So my wife ended up eating my breakfast and I just had some fruit that was in the room. So don't rely on in-room breakfasts at the hotel, it just doesn't work. Make sure you have something in your hotel room the night before, so like a couple of bananas or apples or whatever that you can use as morning breakfast. Now, before you actually write the exam, good foods to eat in the mornings are things like bananas because they have lots of potassium and a little bit of protein and lots of carbohydrates. You can eat crackers with cheese. You can have some milk because it's a great source of protein. Small sausage, those little sausages that are pre-packaged, those are great. Beef turkey is also great too. Before you arrive, I just want to say too that make sure you are wearing comfortable clothing. This is not a fashionable event so nobody cares how you look. Make sure that you are comfortable. If you have a lucky shirt, wear your lucky shirt. I find that those hoodies with a zip-up front are best because they're easy to take off. Hoodies that you have to pull over your head are really uncomfortable during an exam to take off and they often are quite distracting. Wear thick socks with sandals. The most unfashionable possible footwear that you can imagine but the reason why I say this is because unlike say running shoes or regular shoes you can slip off your sandals without bending over and so it doesn't look like you're trying to look at something that you wrote down somewhere. The other nice thing about sandals is that you can scratch the bottom of your feet with the buckle so it's a nice comfort thing as you're writing an exam and is a lot easier. In terms of the clothing itself, wear lots of layers. It starts off really cold in those rooms. So usually the rooms are set at 68 degrees Fahrenheit but there's a thousand bodies in that room that's generating lots of heat so it gets warmer through the day. Hotel-based examination centers are often really cold. Usually, examination-based centers that are based at of a school are smaller and they're generally better temperature regulated. Let's talk about the food that you're going to eat and the drinks that you're going to drink. Beware if drinking too much coffee. Remember coffee is a diuretic. You'll learn that in the pharmacology lecture.

    06:12 This leads to more bathroom breaks and sometimes you can't afford that. How I survived my caffeine addiction during exams is I used to eat this chocolate-covered roasted coffee beans.

    06:24 There is substitute for drinking coffee or caffeinated drinks but remember don't eat too many.

    06:31 We called them java nuts where I live, 5 java nuts is equivalent to 1 cup of coffee so if you're going to eat 2 dozens you're going to be shaking off your chair. So be careful in terms of how much you're eating. I find tea just makes you pea, you know, and you get very little caffeine at a tea so I avoided tea when I was writing exams. Always have a bottle of water though.

    06:54 Some exam centers actually supply the bottle of water and a glass. Don't drink too much and don't drink too fast. In terms of snacks in the exam room, it's really going to be variable.

    07:06 Some exam centers will actually allow you to have snacks and some won't. You will not be able to have them wrapped up. So if you have a chocolate bar or a candy bar for example, you're going to have to unwrap it and leave it unwrapped on the corner of your table and as I said to you before take a sheet of paper off your scratch pad, put it in the corner and use that as kind of a plate. Don't worry about being healthy. Okay look, usually I tell all my students you have to eat healthy so that you can make it through medical school but during exams I catch you a little bit of slack. If you like M&M's, go for it. Open up the bag, dump them on that little sheet of paper that you're using as a plate and then you'll have to give the bag itself to the invigilator as they walk by. Remember that you don't want to be making a lot of paper noises during the exam too. Other snacks if you do really want to eat healthy is dried fruit. Dried fruit is a great source of simple sugars during your exam and it keeps you boyd. The other thing that I see a lot of kids eating are hard candies. I survived on this when I was writing my exams and even to this day when I write my re-certification exams and I go in there I always have a little hard candy. Personally, my favorite are Life Savers and I just keep them on the corner of the desk. Now, if you have a cough or cold or your throat is sore, pick up some throat lozenges, have lots because it'll get you through the exam. Remember, they too have to be unwrapped. It's kind of a pain but unwrap them and put them on the corner. Listen, you're going to do great on your exam. You've got this. Show them what you know.

    About the Lecture

    The lecture Exam Taking Tips for USMLE Step 1 by Pravin Shukle, MD is from the course How to Prepare for USMLE Step 1.

    Author of lecture Exam Taking Tips for USMLE Step 1

     Pravin Shukle, MD

    Pravin Shukle, MD

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