How to Maximize Your USMLE Exam Day Performance

  • /Reviewed by: Amy Rontal, MD
  • Essentials for going into your USMLE exam day feeling confident and prepared.


    Reaching the final stretch of your USMLE exam preparation is a big milestone, and understandably your emotions may range widely from nervousness to eagerness. You’ve worked really hard to get to this point and now, it’s time for that commitment to pay off! Navigating the day of your exam can be a unique experience, and we want to make sure that you’re ready for everything that comes along with it.

    1. It starts with the week leading up to your exam

    Develop a game plan for your test day including what time you will wake up, what your morning routine will look like, and how you are going to get to the test center.

    You should plan to budget plenty of time on the morning of your exam for getting ready, eating breakfast, and travelling to the testing center at least 30 minutes early. It’s crucial to start syncing your sleep schedule at least a week in advance. If you’re a night owl like me, you know the challenge that comes with suddenly trying to shift to going to bed early and then struggling to fall asleep; it’s far easier to do it slowly over many days to make sure you’re able to get a full night of sleep and wake up feeling ready to go on the day of your exam.

    If you have the time, consider making a quick trip to your testing center before your exam day. This will help you get a sense for the fastest route, give you an estimate of how long you should budget for transit, and minimize any chance of getting lost or having difficulty finding it on the morning of the exam.

    For certain USMLE exams, you can also look into doing a sample set of questions, sometimes called the “Free 120,” at the testing site for a small fee. While in no way necessary, if you elect to do this, you can get a sense of the regulations and policies of the testing center before your actual test day!

    2. Maximize your break time

    During your exam, you’ll notice two clocks in the corner of your screen. The first clock represents the time remaining in your current block of questions, while the second clock indicates how much time remains in the exam day. This second clock will also include additional time for breaks; for example, for the USMLE Step 1, you have 7 blocks for which you’re given 1 hour each, however, the second clock’s timer will start at 8 hours so that you have 1 hour of break time over the course of the day.

    You’re free to divide up your break time however you like! You can only take one long break for the entire day, or you can take a break after every second block; it’s really up to you. However, you should try to never take a break during a block, as this will get flagged as irregular behavior. Therefore, before clicking in to start the next section, check in with yourself to make sure you’re recharged enough to keep going.

    My general advice is: take a break once every one to two blocks. Having just a few minutes to collect your thoughts, use the restroom, drink some water, or eat a small snack can goes a long way in helping you be your best before you dive back into the exam.

    A few pieces of advice about structuring your break time:

    • The time you spend on the tutorial at the beginning of the exam will come out of your break time.
      • The tutorial is posted on the NBME website so do this before your exam day! This allows you to skip right through the tutorial on the day of your exam.
    • Budget your time well!
      • Time management is part of what is actually being tested on the USMLE. Any excess break time you use beyond what you are allotted will come out of the time you have to answer the questions in the last block.
    • Once the second clock runs out, it’ll close out the testing interface no matter where you are in the test, so make sure you take this into account when planning your breaks.

    Time management is part of what is actually being tested on the USMLE!

    3. Managing your emotions about the exam

    From the days leading up to your exam, through to the end of your test day, it’s natural to have a host of feelings. Making sure these feelings don’t get the best of you is crucial. In the weeks leading up to the exam, some tips to handle the stress include making sure to carve out time to take care of yourself including eating and sleeping well, staying physically active, and taking time for family and friends. You’re shooting for that maximum performance with moderate stress region of the Yerkes-Dodson curve. Remember: You can do this! You spent innumerable hours and already put in the work to get to this point; it’s simply a matter of transferring the knowledge in your head into the computer interface. Taking my USMLE Step 1 exam was especially daunting after I realized how high-stakes my exam performance would be for the rest of my career. The best way to handle this before or during your exam is to breathe and remember that you have already done the hard work to achieve your goals.

    After you take the exam, de-stress! You have earned it. Hopefully, you have time to spend catching up on tasks (and your life) and are able to be with friends and family doing what you enjoy. The most important point here is that you should not dwell on the exam. Because your performance will be dependent on your percentile as compared to the performance of other test-takers, it’s not worth the energy to calculate what your score will be simply based on your impression of the test. If you found the exam very difficult, the likelihood is that other people did too and the curve will reflect that.

    In general, results are released the second or third Wednesday after your test day at 11 am Eastern Time, and it’s best to completely forget about the exam until then. Enjoy your life and celebrate—this is a momentous moment in your medical training and an incredible accomplishment!

    Breathe and remember that you have already done the hard work to achieve your goals

    You can do this!

    About the Author

    Originally from the Kentucky suburbs of Cincinnati, OH, Mike finished his undergraduate degree at a small Kentucky liberal arts school called Thomas More University. From there, he attended medical school at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, PA, where he was involved in the Medical Student Government, Dermatology Interest Group, and University City community clinic. He completed a preliminary internship in Internal Medicine at Brigham and Women's Hospital in Boston, MA and is currently a dermatology resident in the Harvard combined program. Outside of medicine, Mike enjoys hiking, playing tennis, and just generally being outside. Though the Patriots and Eagles might have Super Bowl wins behind them, he will always be a Bengals fan at heart.