USMLE Test Day Strategy

by Mohammad Hajighasemi-Ossareh, MD, MBA

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    00:00 Welcome back to the 2nd Year of Medical School lecture series. Now in this lecture, we’re going to discuss USMLE Test Day Strategy. We’re going to make you familiar with the test-taking environment, we’re going to discuss how to utilize break, we’re going to talk about the importance of your mental state, and we’re also going to give you tips on how to stay focused and excel on exam day. So, let’s imagine it’s USMLE test day and let’s go through the environment. You have done it at this point, you’ve made it through the 1st and 2nd year of medical school, you studied for months for USMLE Step 1, and the test day is finally here. It’s important though that you ensure that your test day is eventless. You don’t want anything happening today that’s exciting. You want to have the strategy in place to excel on your exam and live happy. So the first variable we need to talk about is the actual environment. When you’re taking the exam in the US and globally, you’ll take it at what’s called a Prometric Testing Center. For the USMLE Step 1, you’re allowed to actually schedule a practice test at a Prometric Testing Center before your test day and this can be weeks to a couple of even months before your test day, you don't have to do it right before. I highly, and by highly I mean just go do it, I highly recommend that you go and schedule a practice test day. What this does is you are allowed to go on the Prometric website, say “Hey, I want to do a practice test day.” You got to pay a little bit but what happens is they let you mock through a few Qbanks in their actual testing environment. The benefit is that this makes you familiar with the drive to the testing center. You get to practice to drive from home to there, you learn about parking for the testing center, you get to sign in to the Prometric Center just like you do on test day, they’ll give you a locker, and hold you to all the same rules as they do on actual test day. It’s a perfect way for you to experience all the unusual quirks and oddities that are present at testing at a Prometric Center. So what happens on test day when you get to Prometric? It’s weird. The Prometric Testing Center is always in some building and it will have a weird lobby. Okay? People will get there and they’ll be checking in. There’ll be lockers there as well in the lobby where students can put their personal belongings in such as food and bags. So when you arrive at the Prometric Testing Center, you need to present the receptionist with your scheduling permit. Okay? This is a 1-page document made available to you online when you schedule for your USMLE exam day. Okay? You also need to bring with you a valid form of identification. Go to the Prometric website for like full details on what are the forms of ID. If you’re in the US, just bring your driver’s license or if you want to bring your passport. If you don’t have those, go to the website and figure out the details of what you need to bring. If you don’t have valid ID to match that scheduling permit, you will not take the test. You don’t want that to happen. Prepare for this. Go on the website and know what ID to bring with you. Print the scheduling permit, put a few copies in your car and your backpack, wherever. You don’t want to miss this silly little detail. Now, once you’ve scheduled the test day, you’re there and you signed in, they will call that checked in. Then they will give you a key for a locker. Okay? You can then go open the locker and put your personal things in there. We’ll talk about what to actually bring with you in a few moments. Then you’ll sit down, you’ll close your locker, and go sit down the lobby, and you’ll wait to be called into the testing room. Once a Prometric Testing Center employee will call you, they will take you to a computer outside of a testing room. This isn’t the testing room yet. This is like another room with another room inside of it, and you’re outside of that room looking in, it’s like one-way glass, and you will stand there like this. They’ll put a webcam. They’ll take a picture of you, then they’ll actually thumbprint electronically your finger. So you take your thumb and go like this on a scanner, and you’ll be scanned. Then they’ll take out a metal. This is getting weird, I know, but just follow along. After they had taken a photo and fingerprinted you, they’ll take out a metal detector and then scan you up and down. They’ll ask you to roll up your sleeves if you’re wearing a longsleeve, they’ll ask you to pull up your pantleg and show your ankles, they want to see your wrists, they want to make sure there’s nothing in your hands, they’ll make you put your hands in your pockets.

    04:28 If your shirt has pockets, they’ll make you do that. They’ll make you turn your pockets inside and out. They do all these to make sure you’re not bringing anything with you. Once this whole dancing charade is over, you will then sign your name and the time going in into a physical binder. Then they’ll take you in to the test room and assign you to take a test on a computer.

    04:49 So all you’ll have with you when you’re going into the test room, they always have you carry your ID, you have to carry your locker key so you'd be able to go back out and nothing else.

    04:58 You’ll only have those 2 items that are allowed in the testing center with you. Once you’ve been shown to your computer, the computer is like a basic boring Hewlett-Packard or Dell computer.

    05:08 It’s a full desktop, you know. Screen, keyboard, mouse, it’s the computer thing there. It’s a whole classic system. You’ll also have over-the-ear headphones available if a question includes an audio file that you need to listen to. Audio files are usually lung sounds or heart sounds on physical exam that they want you to hear and identify the pathology. You’ll also have available at your desk over-the-ear noise-cancelling earphones. These are the kind of the ones you see people at industrial areas or airports wearing when they’re outside these big things. Okay? Here are some more details that you need to know about the Prometric Testing Center. Once you're at your desk, you will have to type in a special code that the Prometric Testing Center employee gave you to sign in to start your test. Okay? So they will tell you the code and you’ll type it into the computer and enter and then like your face will pop up on the screen saying, “Oh yeah, this is me, I’m taking the right test.” At this point, you’ll be given the option to take a 15-minute tutorial but I’m going to tell you skip this tutorial. Okay? Only stop along this tutorial just to make sure during the audio sound check component that your headphones are working. Other than that, you don’t need to look but make sure that you log in to the Prometric website before coming in on test day to familiarize yourself with the USMLE software. So you can go to the Prometric site or the USMLE site. They’ll both re-route you to the same place that will actually show you the USMLE exam day interface and you can play with it. So when you get there on test day, you can hit skip, skip, skip, op the audio section, put on the headphones, hit play, take them off, skip, skip, skip, get those 15 minutes of the tutorial time added on to your breaktime. Also, as a little side quirk, if you study the USMLE World Question Bank, it has an identical software interface, so you’re good from that perspective. So say you’re sitting down, you just finished your first block, you may want to take a break. We will talk about the strategy for breaks shortly. When you do take a break, make sure you click pause on the screen between blocks and then just get up and open the door and go outside and you’re outside there on the Prometric Center, testing employee will be standing outside there. This is the same place they did the whole face and fingerprint thing. They’ll say "Okay, show me your ID. Go ahead and sign on this binder where you signed in, where you’re going to sign out now." Then they’ll let you go off on your break. During this break time, you can go to the bathroom, eat a few bites of a healthy snack, drink a bit of water, do whatever else you want and then when you come back from your break you go to the same employee outside of your testing room and the whole game starts all over again. You got to show them your ID, they scan your finger, the computer has to say, “Oop yup, that’s right. That’s the same finger from before." They take out the metal detector. They scan you. You roll up your sleeves. You show your ankles and wrists. They’ll make sure nothing is in your hand. You empty out your pockets. It’s a game, right. It’s crazy. But you have to do this every single time you want to enter the actual testing area and once you’ve done this, you go ahead and sign your name on the binder again, take your ID and locker key, and then you go back to your computer. Okay? Here is the sad part. This whole charade of checking, security, and fingerprinting, the timer is continuing to run on your break during this time. So, you need to be aware that all of these stuff is happening during a break when you’re scheduling your breaktime and that this amount of time really is lost with the security check-in and check-out process. During the test day, while you’re actually taking the test, a Prometric Testing Center employee will be walking around behind you watching the students. Within the actual testing room, like I said it’s a very sterile environment, you’re sitting in a cubicle, the computer is there and then above you is a camera and there are cameras all around the room and there’s a microphone right above you and there are employees always walking around behind you. Every move and sound that you make is recorded. You cough, you sneeze, you whisper, you scratch or sniff anything, it’s all under observation and it’s all being recorded continuously. Alright? This is very obvious, don’t cheat, don’t talk to anyone, don’t do anything fishy. You will be caught. I mean these rooms have so many cameras, it’s uncomfortable at some times. Okay? Just so you know, this is the environment. Don’t even try to plan for anything sketchy. I guarantee you, you’ll get caught.

    09:44 So, now that we know the very unusual environment of the Prometric Testing Center, how do you plan your breaks, what you eat, what you wear. Now these variables may seem silly to consider but it’s these small things that make all the difference. Right? We previously discussed this lengthy, check-in and check-out process while entering and leaving the room. Since you only have 45 minutes of alloted breaktime and a 15-minute tutorial that you can skip, they’ll be added, so on test day you’ll have an hour of breaktime. Since there are 6 blocks, you will lose roughly 4 to 5 minutes due to this lengthy security process. So I’m going to recommend that you schedule your blocks as follows. This is the schedule I used for my Step 1, my Step 2, and my Step 3 test day. Okay. You go to test day, you sit down, block 1 comes up, you do block 1. An hour goes by. Then, I want you to take a 10-minute break. What are you going to do on this 10-minute break? Alright, I want you to get up, go to the silly check-out thing, go to the bathroom, go to the bathroom everytime. Even if you think “Oh, I don’t got to go,” you’re going to have...

    10:55 if you don’t go, the urge will come in the middle of the next block and you won’t be able to get up and there’s nothing worse than having the urge to want to go to the bathroom while you’re in the block. So go to the bathroom whether you like it or not. Eat a few pieces of an apple.

    11:11 Why do I say apple? One, I like apples and 2, the skin of apples has a lot of energy in them. Just eat them with the skin. Eat a fourth of a sandwich, yes 1/4, and a few drinks or a little sip of some coffee, tea, water, whatever you want. Right? Essentially, what you’re going to do during this 10-minute break is go to the bathroom, rehydrate, and give yourself some calories for energy.

    11:34 Then, go to block 2. Sit down for an hour, do block 2, then you’ll take another 10-minute break after block 2. Same thing. Go to the bathroom, eat a little bit apple, 1/4 of a sandwich, have some fluids. Then, sit down for block 3. Do your block 3. Now, you just completed 3 blocks out of 6. Okay, so you’re now halfway through. What I want you to do now is take a 20-minute break.

    11:57 So you took a 10-minute break, this is your first and only 20-minute break. During this 20-minute break, go to the bathroom obviously, now eat a whole sandwich, eat a few pieces of apple and a few sips of coffee, tea, or water, whatever you like. The point here, this is kind of like your mid-day lunchbreak. This is your time to really refuel, get refocused, go outside, stretch, scream, do whatever you need to. I need you to refocus and replenish during this time. Right? So eat healthy, get yourself ready for block 4. Then go in and do block 4. Another hour goes by, you just did 4 out of 6 blocks. Good job but it’s getting a bit tiring now, isn’t it? So now, take another 10-minute break, same as always, go to the bathroom, eat a few pieces of an apple, eat another fourth of sandwich, and have some sips of fluid. Then come back do block 5. Get block 5 done. Another hour has gone by, 5 out of 6 blocks done. Oh man! Just one more. But first, a 10-minute break.

    12:59 Don’t try to rush it and say “You know what, I’m just going to the next.” Every single block, you will take a break right after. Doing 2 blocks back to back is not my recommendation. If you studied like that and that’s how you did Qbanks at home, okay, there is an argument for it but in my recommendation, take a break after every block. Why rush yourself? You have breaktime, spread it out. So you’re going to do your block 5, take a 10-minute break, go to the bathroom, have some apple, 1/4 of a sandwich, have some sips of fluid, you get the routine, then go in to block 6.

    13:34 Okay? And then take it and you’re done. So, you kind of saw in the schedule I talked about sandwiches and apples, let’s going to talk about what food to bring with you on exam day. Now, I say bring 2 sandwiches with you. One whole sandwich you’ll eat after block 3 and the rest of the sandwiches are spread up 1/4 between all the other blocks. I say eat whatever sandwich you like. Alright? The whole point here is avoid sandwich items or any food items that are sensitive to heat or could go bad. The last thing that you’re going to want is to have some GI upset or aggravation during exam day. You don’t want to get cramps or have to go to the bathroom suddenly, play it safe. I personally like peanut butter and jelly sandwiches per personal preference of mine. I like the high-density calories of peanut butter and jelly just tastes good. I bring apples because the skin of apples contains natural chemicals that give you energy and I usually bring coffee, tea, and water. I drink coffee in the morning in the earlier blocks, tea in the later parts, and water throughout. I personally argue to avoid sugary substances. You know these are things that will cause you to have peak and spikes in your focus and I also say avoid energy drinks because they also give you peak and troughs in energy focus. You want a smooth ride through the exam. Have your coffee, have your tea, have your peanut butter jelly and apples.

    14:57 Just keep it going smooth. You don’t want this business going on. No ups and downs, smooth through the exam. Now notice, you cannot bring any food, candy, beverages, or anything into the actual testing center room with you. You can only eat these things in the lobby or outside.

    15:14 Once you go in, to be all fingerprinted and scanned and checked, all you can have is your ID and locker key with you. Go to the Prometric website and read all the details about things that they’re going to talk about with you. Some locations, for example, don’t let you bring in watches. They don’t want to have that on exam day. So beware of all the small minutiae as well. Okay, clothes.

    15:36 How do you dress for this? Okay. You want to dress super comfortable and on the warmer side.

    15:42 For whatever reason every testing center is always cold. They crank up the AC, it’s uncomfortable.

    15:49 What you want to do is simply dress in comfortable layers so as it gets hotter, you can unzip a jacket or sweater and take that off and as it gets colder, you can put it back on. Just be ready for simple indoor climate change. The AC will be running. Now, let’s talk about the importance of your mental state on exam day. We hinted at this earlier. On exam day, it’s important that you are in the right state of mind. The day before the exam day, just do some light review and just try to relax. Be calm. Don’t do anything wild. You can celebrate after your exam is done. You don’t want to have something major come up before your exam day. Eat clean, exercise, go to bed early, wake up early enough on test day so you don’t have to be in a rush running around.

    16:37 Make sure beforehand you’ve mapped out the drive to the testing center. Know how bad traffic is on that day at that time. Right? These are all those silly logistical details that if you plan out, are baby steps are easy, you’ll have more peace of mind and on test day things will run smooth.

    16:54 The more you have planned, the less you have to worry about. On test day, drive careful to the testing center or have someone drive you and tell them to drive carefully. The last thing you want to do is be late or miss your testing appointment because you got into an accident or got a speeding ticket. If you show up more than 30 minutes late to your appointment, they will cancel you and you will not be allowed in. Something silly you don’t want to happen after all this work you put in to the test day. Now, when you arrive at the testing center, try to ignore the other students who are there. I know that sounds a little bit antisocial but some people are just weird and will come up to you asking questions about the exam. This is the last thing you want to deal with. And there’ll be some students walking around, talking about how they took the NBME practice test the other day, they got a 250+, a 270+. They did UWorld 20 times. They read every.... Okay, we get it. You’re up to something. All of this is just baloney, you don’t need to hear about it. Just ignore these people, sit in your own space, be in your own bubble.

    18:02 Now, throughout the entire test day, I want you to be in your own test space. I want you to be in your own bubble. The less distractions and less of a chance for people to get into your mind and into your mental space. It’s okay on test day to be seen as odd or antisocial. We don’t care.

    18:19 We spent months studying for this. On test day, there is nothing more important than you being calm, focused, and ready to attack test day. Ignore everyone else. On test day, don’t check your cellphone. Not only is this actually a Prometric rule, they don’t want you playing with your phone like you could be sharing info about the test or anything, but what I care more about is that I don’t want anything to distract you. Just focus on the exam. It’s a single day. Just be focused. Think about that old day. Do well in the exam and then go on and get on with your successful life. Don’t be brought down. I don’t want you getting a text from your mom that this and that happened and then it’s going to distract you. The world can continue without you for 8 hours.

    19:03 So here are some tips on how to stay focused on exam day. If you’re taking Step 1, you definitely know how to take an exam and you know how to stay focused for an extended period of time but here are some tips that never hurt to hear and they come from me and I’ve suffered through a lot of these tests. So in the beginning of the test day, you will be fine. You’ll have plenty of energy. You’ll be even pretty excited about the exam, and you’ll notice that once you start the exam, you know things are feeling pretty good. It’s just like the question bank you did at home.

    19:31 Familiarity is good. This is why we did the question banks. Then during the middle of your test day, you might start to feel a bit of fatigue. On block 5, you’re going to be getting tired. On block 6, you definitely will be tired and if this is the case this is where I want you to buckle down. Okay, I want you to double down heavy. What do I mean by that? Okay, listen. The exam is graded in relation to all the other students who take that exam that day. Since all of the people are taking the same test, just different variations, everything is going to be kind of cured against comparing other students. So if you’re getting tired at block 5 and 6, other students will also be getting tired towards the end of the test. During your break after block 4, I want you to go outside because at block 4 after that test you have 5 and 6 left. So you have a break, 5, break, and then 6. I want you to go outside because you’re going to get ready for the homestretch. I want you to buckle down now. Go outside, stretch, yell, whatever you have to do to release that extra energy to bring it back to you, refocus yourself and get yourself amped up. Tell yourself this, if you double down your focus now on these last 2 blocks, it’s going to help your score so much because all the other kids are going to be getting tired and they’re going to start making errors but if you can double down, you can get the most points here and actually separate yourself from everyone else. Also, you will feel good leaving the test center because you’ll know you did your best on exam day, and when you were feeling tired, you buckled down and gave yourself a 2nd refresh. Alright? Let’s talk about a simple technique you can use called full body tensing to help relieve stress during your breaks. On your break, go outside and sit down somewhere. What I want you to do is starting from your feet up to your head, pick various muscles. So your toes, crunch them up real tight and then let them go. Your feet, pull them up real tight and let them go. Your calves, your quads, your stomach, your back, your arms, etc. Work all the way up. Hold that 10 cents tight for 10 seconds and let it go and work all the way up from your toes up to your neck. And then take deep breaths as you do this. This full body tensing technique and then releasing technique really helps release a lot of stress on test day. So let’s summarize what we’ve talked about. The USMLE Step 1 exam takes place in an environment that’s very awkward and sterile known as the Prometric Testing Center. Be familiar with the extensive security process and how it affects your breaks. It takes time away from them. Pre-plan your breaks for test day and the foods you’ll eat. We gave you a schedule to follow and what foods we recommend that you eat. Stay on your own mental space on test day.

    22:19 It’s not worth losing it, it’s the core of what you studied for. Buckle down in the last few blocks.

    22:25 It’s going to improve your score since the exam is scored in relation to other students. Thank you.

    About the Lecture

    The lecture USMLE Test Day Strategy by Mohammad Hajighasemi-Ossareh, MD, MBA is from the course Med School Year 2. It contains the following chapters:

    • USMLE Test Day Strategy
    • USMLE Test Day - Environment
    • How to Plan Your Breaks? What to Eat and Wear?
    • The Importance of Your Mental State
    • Tips to Stay Focused on Exam Day
    • Lecture Summary

    Author of lecture USMLE Test Day Strategy

     Mohammad Hajighasemi-Ossareh, MD, MBA

    Mohammad Hajighasemi-Ossareh, MD, MBA

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    Thank you.
    By Mohamed N. on 30. November 2017 for USMLE Test Day Strategy

    Thanks a lot. Useful lecture. I believe we have a similar testing procedure here in Bahrain. I am not sure

    By Neuer N. on 18. October 2017 for USMLE Test Day Strategy

    very informative and intelligent and useful. This Doctor is exceptionally informed.