Surviving USMLE Step 1 Test Day

  • /Reviewed by: Amy Rontal, MD
  • I know someone who stayed up stressing out most of the night before his USMLE Step 1 exam—and then took diphenhydramine (aka Benadryl) at 3 a.m. to try to fall asleep. He nearly got thrown out of the Prometric test center the next day. Why? His signature after the lunch break was so sloppy from exhaustion that it didn’t match his Driver’s License. Don’t let this be you!

    You have studied hard for weeks or months, spent hours on USMLE World question sets, and your test date is a few days away. You have worked too hard to let a bad night’s sleep or a wrong turn on the way to the test center derail you. How are you going to make sure you show up at the test center ready—mentally and physically— to crush this exam?

    Our most important advice for USMLE Step 1 test day: Do not try anything new. That means no new foods, no new pills, no new study resources, and no skipping (or increasing) your daily caffeine fix. Stick to your routine as closely as possible. You do not want the special good luck dinner of spicy fish to give you diarrhea during your first USMLE question block, or going for three cups of coffee rather than two to give you ringing ears and a splitting, jittery headache during the exam.

    There is one exception to this “nothing new” rule: We STRONGLY recommend that you get accustomed to rising — in advance — at the time you’ll need to get up on test day. Get used to  your alarm clock. Make sure whatever method you’re using is reliable and fool proof. (Anyone who has had their iPhone alarm not go off knows the havoc that can wreak on a normal, low-stakes day.) Figure out how long it takes you to shower and dress (comfortable clothing), eat breakfast, and travel to the test center. Do a practice run in, say, 7 a.m. rush hour traffic to see what you’re in for. Again, if you usually wake up late in the morning, you need to start shifting your schedule at least 1 week in advance to go to bed earlier and wake up earlier.

    Speaking of the test center, make sure you arrive 30 minutes before your scheduled USMLE test time with your scheduling permit, proper identification (unexpired, government-issued form of identification with both your photo and your signature), and simple, bland comfort food and drink to get you through the day.

    Remember that your brain runs on glucose, so you should include some sugary snacks (fruit and chocolate) and drinks (juice and water) as well as more substantial lunch fare to keep you focused. Even if you’re not hungry when you’re stressed/in the zone, strongly consider eating something easy to feed that brain and giving you staying power. The eating accommodations at the test centers are minimal—expect to eat your bag lunch cold in your lap while sitting in the lobby.

    Do not bring USMLE study materials to the test center—studying on test day is only going to make you anxious and detract from your focus.

    So here you are, waiting in front of the test center at 7:30 a.m., feeling scared, excited, nervous, and overwhelmed. All those feelings are totally normal. Take some slow deep breaths, remind yourself that you’ve done everything you can to prepare and that now it’s time to do your best. This is going to be a long day—a marathon, not a sprint; and you have trained well.

    Do not give in to the temptation to speed through the first block while your epinephrine is pumping—you’ll make careless errors. On the other hand, you’ll be exhausted by the last block (7-8 hours later) but you need to maintain your focus. The NBME grants 45 minutes of break time that you can take between blocks. Be sure to use it—there is no extra credit for finishing early. And when you do finish the exam, you probably won’t feel good. You will be tired, you will be anxious about the tough questions, and you’ll wish you had spent more time studying the diabetes drugs. You might even think you bombed the test.

    In our experience, the way you feel after the USMLE Step 1 correlates very poorly with your actual score. You probably did better than you think—maybe much better. So stop worrying about something that you can’t change. You did your best. Take the rest of the day off and do something fun. You deserve it.