The best USMLE Step 1 question strategy

Those preparing for the USMLE (United States Medical Licensing Examination) Step 1 are undoubtedly aware that this is a strenuous undertaking requiring significant preparation. It all comes down to practice and strategy to ensure you’re able to demonstrate you have the fundamental skills required for the medical profession.

How does USMLE Step 1 work?

The focus of this examination is the principles and mechanisms underlying health, disease and therapy types. This is an intensive one-day examination that I divided into seven 60-minute blocks – eight hours in total with breaks included. There is a total of 280 questions, with each section not exceeding 40 questions.

What is the USMLE Step 1 question format?

The examination consists of multiple-choice question with at least four choices each. The question is made up of three parts:
• The stem (this is the information of the patient required for answering)
• The question
• Answer options

8 USMLE Step 1 question strategies

To succeed at the USMLE Step 1, there are a number of question strategies that can be implemented. Here’s a look at some of the strategies that have worked for other successful examinees.

1. Improve reading skills
Some of the USMLE Step 1 questions are extremely long situational analyses that provide you with a lot of detail. You only have 1 minute 30 seconds per question, so it’s important that you improve your speed-reading skills.

2. Improve time management
As mentioned, time is not on your side, so it’s worth getting into a good habit of time management as part of your preparation for Step 1. This is a stressful situation, with long and complicated questions, so it’s important to have a form of time monitoring to ensure you’re keeping up with the pace.

3. Check the last line
Most of the USMLE Step 1 questions don’t necessarily rely on the stem, so it’s worth reading the last line – the question – before reading the stem. This will also put you in a better position to answer questions that do rely on the stem information, as you know what’s wanted while reading over it.

4. Don’t read the options first
Once you’ve carefully read the question and speed-read the stem, you’ll have an answer in your mind. Make sure you’ve formulated this answer before reading the multiple-choice options, as this will make you doubt what you know.

5. Avoid the distractors
Every Step 1 examination has distractors which are disguised as correct answers. This is why it’s best to have an answer formulated before reading the options. However, if you’re completely unsure, use a process of elimination to work through the incorrect answers and distractors.

6. Avoid changing your response
Try to avoid that nagging doubt that sets in once you’ve answered a question as that’s what the distractors are for. Most often, your first answer is correct and you’re now wasting time agonising over it.

7. Return to difficult questions later
If you’ve hit a question that you’re really unsure of, don’t spend too much time on it. The Step 1 questions are not in ascending level of difficulty, so it’s very possible you’ll be able to answer questions further along. Instead of wasting time, make an educated guess and flag the question. That way, you can go back later – if you have time – and think it over a bit longer.

8. Practice, practice, practice
At the end of it all, preparing for the USMLE Step 1 requires practicing previous questions. Fortunately, there are many fantastic online step one review courses you can register with that will provide you with a comprehensive testing and information-sharing platform. This way, you go into the examination as fully prepared as you can be.

Pro tip: Use some of the many free or membership USMLE Question Banks

Remember that there is no negative scoring in the USMLE Step 1 so make sure you don’t skip any questions. Rather implement these question strategies, use other USMLE Step 1 resources and put all that practice to good use. The exam is not there to trick you, but tot ensure you have sound medical knowledge and reasoning skills.

Read More: How to prepare for USMLE Step 1?