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USMLE Test-Taking Strategies



There is no question that the best strategy for USMLE success is to know the content tested. Without content knowledge, your chances of passing, let alone doing well on, the Step 2 exam are slim to none. However, knowing the medicine doesn't guarantee a high score. You also need to be able to APPLY that knowledge to USMLE-style questions. And you need to make sure you can answer the questions in the allotted time! There is nothing more frustrating than running out of time on a standardized test.

In addition, to score well on the USMLE you'll need to keep your composure. There will be many questions to which you won't know the answer. Good test-takers won't panic! They will systematically eliminate the distracters they know are wrong and will then guess and move on.

This page will contain an ever-growing library of articles focusing on test-taking strategies. Some articles will be specific for Step 1; others will apply to all the Steps of the USMLE.

The Four-Step Approach

Think of it this way: You have three chances to get each USMLE question right. If you cannot arrive at an answer using these three attempts, you do not know the answer. Mark your favorite letter and move on to the next question. The key to this strategy is that you always know what you are going to do next. This helps you feel in control and reduces anxiety.

1. Read the Question

This may seem trivial, but studies have shown that most students look at the answers first. Questions cause anxiety and answers provide the solution, so many people go right for the solutions. However, you cannot pick the correct answer until you know what you are being asked! Time reading the question is time well spent. More time on the question means more time spent thinking.

Read the question and pick out key words. Key words are diagnostic information, abnormal lab values, indications of gender or race and any qualifying terms.

Read carefully enough so that you only have to read the question once. Rereading takes time. Read for comprehension the first time.

2. The Prediction Pass

After reading the question, stop. Before looking at the options, try to generate an answer. We call this the PREDICTION PASS. USMLE questions are written so that any expert in the field can come up with the correct answer without having any options present. While you may not be an expert in every field, you should still try to predict the answer before venturing into "answer choice land."

With the correct answer in mind, you are less likely to be seduced by distracters. Remember, they are supposed to distract you and convince you to pick the wrong answer. Distracters aren't just randomly generated; they are answers that sound like they could be right.

3. The Selection Pass

If you see the answer you predicted, scan the other answers to be sure that it is the best. Then, pick it and move on to the next question. This is the SELECTION PASS. If the answer seems obvious and direct, good. Do not convince yourself into thinking the question must be tricky or more difficult. Most answers will be clearly correct. If you find yourself making up a long story why one option is better than another, stop yourself. You are probably wrong. The correct answer should be clearly correct. If two answers seem to be almost the same, then neither one is probably correct.

4. The Final Pass

If, after reading through the options, you are still not sure of the answer, you have one final try, the FINAL PASS. At this stage, rather than trying for a correct answer, you are eliminating those you know to be incorrect. Using this strategy, you can usually eliminate all but two of the options. When you have narrowed your choices down to only two options, you have now arrived at the most crucial moment. The correct action at this point is to pick one and move on to the next question. If you are really unsure of the correct answer, which one you pick does not matter. With two options to choose from you have a 50% chance of getting the question correct rather than the 20% chance you started with.

Make a choice. Many people waste time at this point by not choosing. Some people, when they have eliminated all but two answers, go back and reread the question in hopes of finding some information that will help them choose. Time spent talking with students and watching their thought processes during the exam suggests that this is the wrong strategy. When students reread a question at this point, they tend to add to it or pick out single features that help them feel better about choosing one of the answers. However, it does not help them pick the right answer. By adding assumptions to the question, students may feel more confident, but they are really mentally rewriting the question to be one that they feel more comfortable answering. The answer they pick is then the right answer to the question that they envision, but not for the actual question presented.

If after these three passes: Prediction Pass, Selection Pass, and the Final Pass, you still are not sure of the answer, your best option is to guess. At this point, click any letter and move on to the next question. Remember, the key to doing well on this exam is to train yourself to make choices. If you do not know an answer, admit it, make your best guess and move on to the next question.

NO ANSWER COUNTS THE SAME AS A WRONG ANSWER !

Try out this four-step method as you do practice questions in the weeks before the exam. If it helps you feel in control of the questions, that's great. If you find it doesn't work for your test-taking style, it might be too late to adopt it now. Remember, you need to do what works for YOU.

Tips for Exam Day

Taking the USMLE is NOT the most important day of your career; it's just another hurdle on your way to becoming a licensed physician. Keep it in perspective. Treat the exam like what it is, a routine mechanical exercise. Deal with each question as you come to it, make your choice, and then move on.

No matter how well prepared you are for the USMLE exam, you will get many questions wrong. Be prepared to feel stupid. This is not an exam where you should expect to know every answer. Remember, 70% correct puts you well over the mean! Knowing this, your test-taking strategy should be somewhat different than it may be when you take other exams.

Few test-taking tips

1. Arrive at the Sylvan Center 30 minutes early so you are not rushed and have time to get organized.

You will be given a locker to store your personal items and then assigned a computer station. Remember that you have a total of seven hours to complete 350 questions, and a total of one hour to be used throughout the day for breaks and lunch.

2. To cope with fatigue, you will need to schedule breaks.

Our recommended schedule for the exam is:
Question Block Break time at end of Block

Block 1

---

No break
Block 2

---

5 minute break
Block 3

---

5 minute break
Block 4

---

30 minute lunch break
Block 5

---

No break
Block 6

---

10 minute break
Block 7

---

Done!This allows you 10 minutes extra to use as needed.

Remember that you will need to sign in and out when you take breaks. You should also be aware that if you leave the exam room during a block, it will be marked as an irregularity in your testing session. Therefore, you need to consider after each block whether you want to take a bathroom break.

3. Start with the beginning of the question block and work your way to the end.
The idea here is to get into a rhythm that will help create what one psychologist calls a "Flow" experience. The flow experience is a state of optimal concentration and maximal performance.

4. Do not skip any questions.
If you don't know it when you come to it, you are not likely to know it later. Skipping around wastes time and can end up confusing you. Deal with each question as you come to it, answer it as best you can, and move on to the next question.

5. Limit your use of the marking feature to no more than two or three questions per block.
Of course you should answer each question as you come to it, but you may want to double check yourself on a few questions. The marking feature lets you return to review and reconsider questions if you have time left over. Used correctly, marking will help you revisit questions where you have a high probability of getting the answer correct. Misused, marking causes you to not give a question your full attention the first time around. You simply may not have time to go back and look at questions you have marked, especially if you mark a lot of them.

6. Be cautious about changing answers.
In general, your odds of changing a correct answer to a wrong one are so much higher than the reverse that it is simply not worth the risk. If you change an answer, you are most likely making it wrong! Your first impulse is usually the correct one. Stay with it unless some clear insight occurs to you.

7. If you finish a question block with time left over, go back and "check" only those answers that you have previously marked.
Checking almost always leads to changing and tends to reduce your score. If you have a spare moment, make sure that you have entered an answer for every question in the block and then, relax. Sit, take a break, and mentally prepare yourself for the next block of questions. Focus on the questions to come, not the ones that are past.

8. Monitor your time.
Know how much you have left, so you do not find yourself rushed at the end. Work on your pacing from the beginning of the question block. Check your watch every 10 questions to make sure you are on the correct pace to finish. If you pace yourself throughout the block, you should not be squeezed for time at the end.

9. Relax.
During the breaks between question blocks, try to relax and not think back over the exam. The desire to recall questions is strong, but not helpful. Those questions are in the past; you will never see them again. Focus on relaxing and making the most of your break. Remember, you will always tend to remember those questions you get wrong.