You’ve put in weeks of dedicated study for a single day of testing. No matter what your target score is, you’ll likely experience anxiety leading up to test day. It’s important to prepare mentally, physically, and emotionally for your approach to test day. These are a few tricks that I learned the hard way that will help your test day run smoothly.
1. Adjust your sleep schedule in advance
I am not a morning person, but knowing that my test would begin at 7 am, I started my study days at 8:30 am. Several days in advance of my test, I started to transition my schedule even earlier. Two days before the exam, I was not only waking up naturally at 5:30 am, but I was also able to fall asleep earlier, allowing myself to easily get 8 hours a night. It’s challenging to fall asleep the night before a USMLE exam, but you should do your best to set yourself up to sleep early and be well-rested for test day.
2. Don’t try to cram the morning of, or during breaks
I have friends who woke up early to cram on test day. Do not do this. Your brain is going to get a massive 7+ hour workout and you need to reserve your cognitive energy. Instead, use your commute to the Prometric center to get yourself in the right headspace. I blasted my favorite album (Arcade Fire’s Funeral, for those interested) and played my favorite song just before walking in (“Rebellion Lies,” if you’re still interested). Others find it helpful to do guided meditation before the exam. Similarly, don’t study during breaks or try to look up answers from the previous section (the latter will drive you crazy, and definitely won’t improve your score). Use your break time for restorative activities like taking a few deep breaths, eating, and use the restroom.
3. Bring light layers (without pockets) and some liquid fuel
Besides triple checking that I had my government-issued ID and testing permit, I didn’t know what to bring to the test center. I’m always cold so I brought a down jacket. Unfortunately, it was considered “outerwear” and not allowed inside the testing room. Instead, I recommend wearing layers, with a comfortable, warm sweatshirt as your outer layer. Avoid pockets as much as possible, as you have to turn them inside-out after every break. For lunch, I packed a turkey sandwich, granola bar, and smoothie. I was especially happy to have a smoothie that I could quickly gulp down to refuel my brain when I was too stressed to feel hungry. While it’s important to stay hydrated, you should also be careful with beverage consumption. I drank a huge tea while driving to the test center, and halfway through my first section, I thought my bladder might explode. Overall, aim to spread out your eating and drinking across breaks.
4. If you get stuck on a question, mark it and move on
Let’s talk more about that first section. For me, I felt stunned by my very first question. I stared at it for too long before realizing I needed to move on. Later on, I got into a groove and calmed down significantly. When I returned to that first question, it seemed simple. If you get stuck like this, move on and come back. Many students spend too much time on early questions and need to play catch-up later, or waste inordinate amounts of time on difficult questions, and instead of focusing more on “low hanging fruit” (easy questions) during a first pass. You may get stuck on “impossible” questions on concepts that you will have never seen before, no matter how much studying you’ve done. No amount of staring at the screen will get you closer to an answer and you may have to guess and move on. Conversely, you will have some questions that seem too easy. Do not overthink these questions; allow yourself to go with your gut and cash in the easy points.
5. Be careful about skipping breaks
About halfway through my test, I said to myself, “Wow, you are really doing this!” While I had marked 30 out of 40 questions for review on my first section (a bit excessive, objectively), I began to realize which questions I could figure out with more time, and which questions I needed to leave behind forever. My confidence increased, and I became calmer throughout the day. However, my last section was by far the most difficult. I didn’t take a break between my 6th and 7th blocks because I wanted to get the test over with, but I was mentally exhausted and barely reviewed my 7th block. In retrospect, I wish I had slowed down and used my break time between every section.
6. You’ll probably feel awful when the test is over
When I finally finished, I felt terrible (a feeling common even among top-scorers). I agonized over the questions I could remember. I looked up something and realized I had gotten the question wrong, and I ruminated about it for days. Please, do not try to figure out the answers afterward. This may give you a false sense of control temporarily, but will ultimately only increase your anxiety. The best advice I can give about the USMLE is that even if you feel miserable at the finish line, this says nothing about your score.
7. Enjoy a well-deserved break after you finish
The next day, I flew to Austin to be with my best friends from college, none of whom are in medicine. They did not know the term “USMLE,” let alone the difference between a 200 and a 260. They were just proud of me for taking the “boards” and proud that I was on my way to becoming a doctor. My final advice: seek out these people in your life – whether it is old friends, your significant other, or your parents – after your exam because they are right. You will have accomplished something incredible. You will have taken one of the hardest exams in the country, and you will have gotten through it.
Phoebe is in her final year of a combined MD program at Oregon Health & Science University, and is currently completing a one-year Pathology externship. Phoebe scored a 254 on Step 1 and a 262 on Step 2 CK, and currently tutors for Step 1, Step 2 CK, and Shelf Exams with USMLE Pro. Teaching is her passion, and she has over 300 hours of experience tutoring medical students.
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