My Experience on the USMLE Step 1- Test Day

After 10 long months of preparing for the USMLE step 1, I finally scheduled my exam for October 8th, 2018. When I scheduled my USMLE exam I was feeling a mixture of “am I good enough to take this test?” and “I can’t wait to get this test over with!”.

Thanks to my extensive preparation and the wonderful advice I received the past year from my colleagues, the day of the test I woke up ready to rock. It was the first time before an exam that I was able to get a full eight hours of solid sleep, and this was the most important exam I had ever taken so I was thankful for a great sleep.

Both Denzel and I agree that the reason we slept so well was because the day before the exam (Sunday the 7th), we did absolutely NOTHING study related. We woke up and went to 9:00 AM hot yoga 75-minute class. Then we went to a favorite lunch spot of ours- Papalote’s Taco House. We followed lunch with a 60-minute hot stone-deep tissue massage. We did make sure to stay super hydrated all day Sunday, mostly because of all the activities, but also because on test day I always felt dehydrated. We spent the rest of the day relaxing and watching movies and TV shows. I got all of our snacks and materials ready for the following day. We got ready for bed at 8:00 pm and took some ZZZ-Quil to ensure a goodnight’s rest. This routine really worked, I wish I had implemented this before I took all of the NBME exams.

In the morning, we woke up and made the same breakfast we had most days and drank our coffee the way we always have. We woke up at 6:00 AM so we would have 2.5 hours before our exam. We listened to some peaceful music and left at 7:00 AM to get to the Prometric center. We arrived early, which was wonderful for our peace of mind. We were actually able to start our test at 8:00 AM.

Although I planned to follow a day-of schedule as follows:

  • Skip 15 minute tutorial to add 15 minutes to break time (60 minutes total)
  • 2 blocks
  • 10 minute break
  • 2 blocks
  • 30 minute break
  • 1 block
  • 10 minute break
  • 1 block
  • 10 minute break
  • 1 block

I actually ended up with the following on test day:

  • Spend 5 minutes doing a mind dump onto my dry erase board, then skip the rest of the tutorial. (You ARE allowed to write during the tutorial, as soon as you put your CIN code into the computer you can write anything you would like- confirmed by Prometric)
  • 2 blocks
  • 10 minute break
  • 2 blocks
  • 30 minute break
  • 2 blocks
  • Remainder of my break time
  • 1 block

Not all things in life go as planned, and my day of schedule was one of those things. Honestly, I was happy with how my break schedule turned out. I felt like I made the most of my breaks. During my breaks, I would get a drink and a snack, use the restroom, look at my book if I needed to, and just breathe.

In my bag I packed

  • One big frozen bottle of Gatorade (I drank all of this, it was one of the only things I could stomach)
  • Two bottles of water
  • Mini muffins (best thing I brought, it was the only thing I really ate through the test)
  • Pringles
  • Lunchable-type snack packs (I wouldn’t recommend these, I did not eat mine)
  • An apple and an orange
  • My First Aid book
  • My “Day-Of Test Sheet” with a bunch of random things I often forget
  • Ibuprofen, allergy medicine, Pepto-Bismol tablets
  • Cough drops (you can have them unwrapped at your desk- helps with dry mouth!)
  • Foam earplugs
  • Hoodie with no pockets
  • Our passports

The most important tip I would give anyone for game day is- BE PREPARED. I felt so much peace and confidence that day, because I was well-rested and prepared. I felt like I could walk in the test and truly show my knowledge without anything else getting in the way, especially my OWN anxiety.

I have extremely bad test anxiety. I even experience anxiety when I take UWorld blocks daily. Sometimes, my anxiety gets so bad that I cannot breathe and I get a terrible cough. I understand how debilitating anxiety can be when taking important exams, so being prepared and taking the day off before the test is a way to help silence test anxiety. I had minimal anxiety the day of my exam. Of course during the first block my adrenaline was pumping and I could hear my own heart beat, but it quickly calmed down. I think the most frustrating thing was waiting for someone to check me back in or out during my breaks (remember that, because it cuts into your break time).

NOW ABOUT THE TEST ITSELF.

The first two blocks I felt like I was doing awesome! I felt like I knew a lot of the answers, not much tripped me up. People are right when they say the USMLE is written to have a clear answer. In my opinion, the questions were not like the NBME Comp. They were simpler in the way that I didn’t feel like I was being tricked.

The third and fourth blocks were more challenging. I still felt like I knew a lot of information, but there were more questions where I was stuck between two answers or even had absolutely NO IDEA what they were asking me about. When I looked more into those questions on my breaks, it seemed like 50% of the time I chose the right answer when I was between two answers and even guessed a few of the ones I had no idea about. During the fourth block, I started to get a massive headache. I was getting tired after answering so many questions and the light on the screen was bothering my eyes. My anxiety started to get the best of me, so I had to take a moment to pull myself together and get through the block. To me, the fourth block was the hardest mentally and question-wise.

During my longer lunch break I took time to reset myself and hydrate. My headache went away and I changed my mind set to believe this was a whole new test and to not worry about block four anymore. I went back in with a lot of energy and confidence to finish the test.

Blocks five and six moved along smoothly. I didn’t think they were too challenging, but I did have to think about the questions and answers more since my mind was so exhausted. I still finished with about 5 minutes left per block to review. I did stand by my rule for the most part to never change answers unless I had a very good reason to, so I didn’t change many answers during my review (I did in one block and got the answer wrong- DON’T DO THAT).

After my last break, it took so long to get me checked back in that I started my final block with 4 minutes already gone. I was afraid at first, but I felt like the last block went by fast and I still had time left over.

Throughout the test, my most challenging questions were the “up, down, up, up” type of questions. I had several of these on each block. We had some hard statistic calculations, but for the most part the statistic questions were straight forward. I had two heart sounds and two ECG questions, but Denzel had four heart sounds and four ECG questions. We agree that these questions were not necessarily hard, but just took a bit more time. To our surprise, there were not that many bio-chemistry questions- which sucked for us, because we spent so long preparing for them! The micro and pharm questions were fair and not too complicated in our opinion. Behavioral questions were also fair and quite repetitive. We agree that the hardest questions were the physiology and the random pathology questions that were on diseases we had not learned about.

My approach to taking the exam was:

  • Read the question and answer what they are asking you, not what you WISH they would ask
  • If you read the question and you know the answer, answer it and move on without overthinking or spending too much time on it.
  • If you read a question and you have to narrow down the answers, you are stuck between two, choose your favorite one, mark it and move on.
  • If you read a question and you have no clue what is going on, make your best guess, mark it and move on.
  • At the end of the block, if you have time, go back to your marked questions, re-read the question and if you feel the same way you did before DO NOT change what you already chose (your gut knows things better than your mind sometimes!)
  • Sometimes, something will click and you’ll have a reason to change the answer. This is the only time I change an answer!
  • If something on a questions triggers a thought or memory, write it down on your white board incase it comes up on a later block, or if it is something you want to look up during a break.

After the test, I walked out, felt super weird, not good or bad, and spent an hour looking up answers in my book and online. Everyone always says you shouldn’t bring your First Aid book with you or look up answers between blocks or after the test, but every since I started medical school this was something I had to do to keep my peace of mind. So I would say, do what is best for you.

A week and a half later after my USMLE Step 1 exam, I still feel weird and think about a couple questions that I cannot find the answer to or get off my mind. I think that is normal. I don’t know if I passed, I don’t know what range my score is in, I don’t know when I will get my results. All I know is I am happy, I feel free, I feel proud of myself and of Denzel. I do not have any regrets; I do not wish I changed anything about my study plan. There was nothing I wish I did more or less of.

This blog post is an account of my personal experience taking USMLE Step 1. I am not an expert. I don’t know my results. I have only taken this exam one time, so I don’t think my approach will work for all people. But this is a genuine description of my day and my feelings, it worked for me and it worked for Denzel.

After I get my results, I will share a post on how I studied for and prepared for the USMLE Step 1, but until then please feel free to reach out to me on social media or through email below. I am finally on a month-long break before I start IMF in November back in Miami, Florida. I would be happy to speak with or help anyone with questions about passing NBME Comp, or even about my personal experience with the USMLE.

Thank you to all of my family and friends and colleagues for the support this past year. It has been a rough year and I know I have been overly consumed by studying for this exam! I am looking forward to what is to come, and I cannot wait to share more with my YBtoMD followers during clinical rotations!

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