Dr. Kristen Cross and Dr. Alyssa Ehrlich contributed to this post.
The USMLE Step exams strike fear into the hearts of many students. Their notoriety precedes them as exams with extensive content coverage, 7 to 8 hours of question blocks, and the added pressure of being one of the most important factors in students’ residency applications. There are extensive resources and guides online that give advice on how to prepare for the exams. Many resources exist about how and where to acquire content and how to take care of yourself during the multi-week study period. These are all critical components to your success on the exam, yet I want to focus on a less-often discussed topic: maximizing test day performance with specific, intentional training. I want to focus on an important topic that not many guides cover: maximizing test performance with intentional training.
During my 7-week study period, it was helpful for me to think about preparing for this exam as if I were preparing for one of my jiu-jitsu, or martial arts, competitions. When we think about preparing for a physical endeavor such as a sports competition, it is easy to see how mental and physical stamina, as well as many hours of practice simulation, are important. Acquisition of the foundations is not sufficient if we are unable to execute them under high-stress conditions.
The first step is to assess your current stamina and performance
In order to gauge how well you will perform with mental fatigue during a 7 to 8-hour exam, you will need To understand one’s reaction specifically to the mental fatigue of a 7- or 8-hour exam, it is best to simulate the testing conditions as precisely as possible. As there aren't full-length practice exams available online, I recommend purchasing two NBME exams and taking them back to back. Find a quiet place in which you can sequester yourself, without distractions, for the duration of the exam. Bring only the things you will be able to have during the exam, including a blank sheet of paper, a pencil, and earplugs if you desire. If you are able to maintain stamina through 8 sections, you can be confident that you’ll crush 7 sections easily.
Note how your brain functions during testing fatigue
During this practice exam, you will feel fatigued. It’s important to understand how your brain functions when you are experiencing testing fatigue. After you have completed the test, reflect on how it went. Were you running out of time during exam blocks? Were there sections in which you made foolish mistakes? Did this happen more often in the final blocks? Did you change correct answers to incorrect answers multiple times, and did you do this more or less often towards the end of the exam? Doing a practice exam early in the study period will help you to see your progress in content acquisition and stamina. Using this information, you can then refocus your efforts on your weakest testing points.
Develop a strategy
I also used timed mode for all UWorld question blocks throughout my study period. The common argument is that students avoid this on the first pass because they don’t want to “waste” questions. However, there will be questions that you do not immediately know the answer to on the exam, and it is essential to strategize how you will deal with those situations.
Many students struggle with test anxiety, and I myself am one of them. One of the most significant triggers of anxiety is the unknown. The more we can cultivate a sense of confidence in our knowledge of the material and the test itself, the less likely we are to trigger those fears during the exam. But it’s important to recognize that there are challenges that can be solved ahead of time by increasing knowledge of the content, and others that require increased confidence, mental and physical stamina, and a calm and focused mental state on exam day. The best way to accomplish this is through consistent repeated simulation of the test. As a tutor, I enjoy helping students build these skills over the course of their study period, as I truly believe these are skills that anyone can learn.
There are other practices that increase stamina. Exercise that pushed me to my physical limits, such as high-intensity cardio or weight training, was important for me. Developing a sense of confidence in yourself that you can succeed in difficult situations is essential for cultivating mental clarity on test day. Practicing these situations beforehand does not mean that you will not experience stress on test day; you most certainly will. But feeling certain that you can face these challenges and succeed is the key to calming the mind so you can concentrate your energy and focus where it counts when the big day arrives.
The rebuilding phase
The rebuilding phase is just as important as strength training. Eating well and getting enough sleep are crucial to support brain and body function. Supporting yourself in other ways, such as social time with friends and loved ones, meditation, taking walks outside, watching TV, or whatever is recharging for you is also incredibly important to maintain your health throughout the marathon study period. I did not achieve my goal scores by self-deprivation and pushing myself to my limits every hour of every day. Rather, these skills are built in the same way we train our other muscles: through intentional, consistent practice, supported by wholesome nutrition, sleep, and emotional support.
Ready to take your studying to the next level? Schedule a free consultation with USMLE Pro. We can help you develop a personalized study plan that addresses your unique challenges and learning style, guiding you towards your Step 2 CK success.