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How to Avoid Running out of Time on the USMLE Step 1

Medical students share advice on how to train yourself to answer Step 1 questions at the right pace.

Are you prepared to deal with the format of Step 1? In addition to the challenge of learning and recalling the content, you will also be asked to work under time constraints. As Loma Linda medical student Michael Douglas recalls, “I was doing well on the practice exams, but when it came to the real thing, I was running out of time. That was totally new.” In addition to timing, the presentation of the content on the test can be a challenge as well. “Sometimes they’re riddles so you’re spending half the time interpreting the question,” Michael says. We asked five medical students how they prepared to perform on exam day. Here are four tips for using your study plan to get comfortable with the test’s format.

Start early with your question banks

Medical student Ethan Young’s strategy was to work on practice questions every day from the start of his study plan. “Six months in advance of the exam, I began trying to do about 10 questions per day from the USMLE-Rx question bank,” Ethan says. For Ethan, this approach benefited him in two ways. “This doesn’t seem like much,” Ethan says, “but it really helped me become acquainted with the format of board questions as well as boosted my knowledge.” For a more detailed discussion about the advantages of starting your Step 1 QBank early in your study plan, see our blog post titled, “Top five reasons to start using your USMLE Qbank early”.

Use a QBank or self-assessment that is representative of Step 1’s format

To prepare for the kinds of questions and exercises you will see on the exam, choose a QBank or self-assessment that mirrors the actual exam. Ronald Russo of the Medical University of the Americas tells us that “the questions on the UWorld self-assessments are more similar to the Step 1 than NBME-style questions, and UWorld definitely has the best explanations of any question bank.” Ronald believes that the questions on the NBME self-assessments are not as representative because “the vignettes on the actual test are longer.”

On the other hand, Ronald tells us that the NBME was a strong predictor of his Step 1 score. While the UWorld self-assessment overestimated his score, the NBME score was with 7 points of his Step 1 score. Michael Douglas agrees, saying, “I actually did an analysis of people who reported their scores and how they correlated with NBME tests. They were pretty dead accurate.” Still, Ronald says that he recommends using both UWorld and NBME self-assessments in your study plan. “I definitely think it’s important to use both,” He says, “You get 400 new questions from UWorld, with explanations. Whereas, with NBMEs you don’t get explanations.”

Read the QBank explanations, even the explanations for the wrong answers!

Spending time to learn how the test justifies right and wrong answers should be part of your study plan. This can help you tackle bewildering questions on exam day and keep a consistent pace. University of Pittsburgh medical student Thomas Mike shared his advice for using QBank with us. He says, “always read the explanations, even if you get the answer right.” Using “Tutor Mode” for UWorld will allow you to review the right answer and an explanation as soon as you mark your answer choice. Cram Fighter user and medical student Kate Wentworth found this instant feedback to be especially helpful in her preparation for Step 1. Consider choosing a QBank with strong explanations for spotting wrong answer choices. Kate says, “COMBANK gives you a good explanation of the right answer. But the wrong answers would essentially say, “it’s wrong because it’s not the correct answer.” UWorld felt like the most bang for my buck. I could learn a lot more by reading the explanations for wrong answer choices as well.”

Thomas Mike Always read the explanations, even if you get the answer right.

Thomas Mike, University of Pittsburgh

Use timed practice and adjust your pace as needed

When we asked Michael Douglas what advice he would have for medical students preparing for Step 1, he said, “try to work on your pace. Don’t ever think you’re moving too fast.” In Five More Mistakes Students Make with UWorld, Brian Radvansky of Med School Tutors explains that using “Timed Tutor Mode” or “Tutor Mode” in UWorld can “build a pattern of repeatedly throttling and braking.” He says, “you will be much better served by coming out firing, answering questions for a full hour, then taking a breath and reviewing those 44 answered questions over the next 2 hours. Simulate the REAL THING!” Thomas Mike told us that his last week of studying consisted of “1500 more questions in a crazy rapid fire fashion just to work on my speed and thought process. I knew the information was there in my brain, I just needed work on improving my recall.” In his study plan, this type of practice was essential training for exam day.

Michael Douglas Try to work on your pace. Don’t ever think you’re moving too fast.

Michael Douglas, Loma Linda School of Medicine

Preparing for the Step 1’s format can be summarized like this: use practice questions effectively, and use them early. Get acquainted with the test’s presentation of the material and the test’s justification for the answers by doing questions every day and thoroughly reading the explanations. You can simulate the Step 1 as closely as possible by choosing a representative QBank and doing timed exercises. Follow these steps, and you will become familiar with the format before you show up to take the test on your exam date.

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