4 Time Management Tips to Score Your Best on the USMLE Step 1

  • /Reviewed by: Amy Rontal, MD
  • As a USMLE Step 1 tutor, I work with students who have a variety of strengths and weaknesses. While these students are all very different, most seem to share a common struggle when it comes to Step 1: time management during the exam.

    With only one hour per 44 questions, it’s essential to make the best use of your time to maximize your exam score.

    As a student who typically has had extra time leftover on exams, studying for Step 1 was a wakeup call for me. I frequently had to rush at the end of UWorld q-sets and would end up making careless errors I wouldn’t have made had I had more time. On my first NBME, I never had time to review my marked questions during the test, and even ran out of time completely on one section. With time and effort, by exam day, I was able to finish every section in a timely manner. This is something every student can to learn to do by following 4 key tips:

    1. Start every question by quickly reading the last sentence and scanning the answer choices.

    This is a great time saver for several reasons. As an example, a question could start out with a lengthy description of a patient presenting with all the signs and symptoms of cystic fibrosis. The question will then read, “Which of the following is the most common mutation in cystic fibrosis?” No matter what the presentation of the patient is in the vignette, the answer to this question will always be “ΔF508”. For these inalterable fact questions, it’s a waste of your time to read the entire vignette, and by reading the last sentence of every question first, you can save valuable time.

    Furthermore, on questions where the vignette does matter,  you can get a better idea of what to think about while reading the vignette if you look at last sentence and choices first. For example, a student reads a long vignette about a patient with paralysis after an accident. When they finally get to the question, the question asks which deep tendon reflex would be strongest in the patient. At this point, the student doesn’t remember all the details of the question and has to use time rereading the question to assess where upper motor neuron vs. lower motor neuron damage occurred. If a student reads the last sentence of the question and scans the answer choices prior to reading the vignette, they pay attention to which areas have upper vs. lower motor neuron damage the first time they read the question. This saves valuable time that can be applied in other places.

    2. Be aware of timing benchmarks

    It’s unrealistic and distracting to try and track exactly how long you spend on each question during the hour block. Therefore, knowing general benchmarks of time can help you track your time management without taking away your focus from questions. For every 11 questions, you are given 15 minutes.

    Therefore, you should aim for the following:

    Start of question #:  Minimum time remaining:
    12 46
    23 32
    34 18

    Knowing the benchmarks and tracking your progress gives you the ability to fix timing mistakes before it’s too late. Many students don’t realize they’ve been using too much time until they have 10 questions and 4 minutes remaining, resulting in them not answering questions at the end that they could have gotten right. If you’re at question 23 and you know you’ve used a few minutes too many, you can make an effort to move slightly quicker through the remaining half left so that you get through all the questions.

    3. Only mark questions that more time will help with

    Your goal on Step 1 should be to allocate your extra time only where it will make you more likely to get more questions correct. Therefore, you shouldn’t mark every question you’re unsure about. Instead, you should mark questions that fit the following two parameters: questions that you’ve narrowed down to 2 or 3 answer choices and questions that are critical-thinking based. If a question is extremely difficult and you have no idea what the answer is, spending more time is unlikely to help. Similarly, if the question is a rote memorization question of gene name or drug that you don’t know, spending an extra minute to try and remember is unlikely to work. Instead, mark and spend time on questions where the extra minute may give you a new insight, such as deciding which of two similar pathologies is a better answer choice based on symptoms and lab values in a vignette.

    4. Don’t panic!

    Out of all the tips, this one is probably the most important. No matter what happens, no matter how bad it seems things are going, panicking will never ever help. Panicking will only waste time, take away your confidence, and make you perform poorly. If you spend too much time on a question early in a section, acknowledge the situation, remain calm, and put your best foot forward. You can’t take back timing mistakes that have already been made, but by not panicking, you can prevent them from snowballing and affecting your entire exam.

    Always remember — it is possible to recover from poor use of time. During the 4th section of my exam, I got very confused on question 3 and ended up spending 10 minutes on it. When I finally moved on, I realized that I had spent WAY more time than I should have. For a second, I felt like panicking – but I realized that this would only make things worse. I proceeded to work my way through the rest of the questions as efficiently as possible, making sure to make decisions quickly and not waste anymore time. I ended up finishing the section with a minute and a half to spare, and ultimately received a Step 1 score I was very happy with. By not panicking and working wisely with the time I had left, I managed to save what could have been a disastrous situation!

    By following and practicing these 4 tips, you will be able to better manage your time and maximize your score (and keep your future self from giving you grief). Best of luck!