Surviving Step 1: Test-taking Strategies

By Walter Wiggins

As you prepare for the USMLE Step 1, one of the things you should be doing every day is practice questions. I firmly believe in the importance of using a question bank, so I’m going to present my test-taking strategies with the assumption that you’re using one. I’ll also assume that you’re going to take a self-assessment or two in the process to give you a chance to figure out your test-taking strengths and weaknesses with respect to Step 1. Clearly, time management is going to be an important issue for most people, so there will be a considerable emphasis on methods for maximizing your use of time.

When you begin studying, you may decide that you only need to do a few practice questions at a time. This is fine, but I encourage you to quickly transition to practicing questions as if you’re actually taking a block of the Step 1 itself. You won’t know how much time you’re wasting or if you’re rushing too much until you try it. Also, you’ll get a better feel for your fatigue threshold if you practice in this manner. As discussed previously in this series, each Step 1 block consists of 46 questions, which you have 60 minutes to answer. It’s helpful to configure your question bank for practice sets the same way. Self-assessments are generally designed this way as well, but you should make sure that this is how it’s set up before you start.

When approaching questions, I suggest you start by reading the actual question before you go through the whole vignette. Each question will have a paragraph or so of text associated with it; beginning with a vignette (or mini case scenario) and ending with a question. It helps to know what you’re looking for before you read. You may also choose to read the answer choices. Make sure you read the entire vignette before you answer the question. Sometimes “trigger words” show up early and make you think of a particular answer, but these may be misleading.

Once you’ve read the vignette and are sure you understand the question, try to answer it. If you are certain of your answer, great! If not, see if you can narrow down the choices. Remember that Step 1 questions are looking for the best (or most likely) answer, not just a correct answer. There may be times when more than one answer could be correct, but one answer is more likely than the others. If you can narrow it down to 2 or 3 choices, but aren’t sure which is best, guess and move on. You will not be penalized for guessing wrong. I suggest you flag the question and come back to it if you have time at the end of the block.

If you can’t answer a question: pick any answer, mark it, and move on. Odds are – if you don’t know the answer when you finish reading the question, it won’t come to you in the next 3 minutes of pondering over the question. However, in some cases, a later question may remind you of the answer or at least help you in narrowing down the choices. But you will waste enormous amounts of time, and potentially miss your chance to answer other questions correctly, if you spend too much time on any one question.

Once you have made your first attempt to answer all of the questions in a block, you can go back to answer any marked/flagged questions, if you have time. Unfortunately, you may not always have time to go back. This is why it is extremely important to always guess if you can’t come up with an answer in a reasonable amount of time. There is no penalty for guessing and it’s possible that you’ll choose the correct answer.

The most important point here is to get consistent practice. With practice, you’ll understand more about your own ability to finish the block in the time allotted. You’ll also get faster as you get better at answering (or attempting) questions efficiently. But again, don’t rush! If you jump to a conclusion without finishing a question, you may miss an important point.

What’s your most effective test-taking strategy?