Lessons I Learned During My USMLE Step 1 Exam
The USMLE Step 1 exam was the most daunting test I’ve ever taken. That it covers anything—anything—from the first two years of medical school is enough to send shivers through most medical students. There’s a wealth of advice about preparing for the exam, including which flashcards to review, how to plan your dedicated study, even how your NBME practice scores might correlate with the real thing. But what about actual test day? What can you expect when you walk into the test center? Having recently taken the test, here’s what I learned from sitting for the exam:
- Be prepared to wait, and ensure you have your permit and the appropriate identification
Checking in at the test center may take longer than anticipated, especially if your center is in a densely-populated area. My center scheduled all medically-related exams on the same day, which meant it was crowded with students taking Step 1, Step 2, and various shelf exams. While the staff worked as efficiently as they could, I still waited for about 20 minutes—which can feel like an eternity if you’re nervous. I learned that some centers allow you to arrive early for your appointment to reduce this delay, so if the idea of waiting in a room full of stressed medical students isn’t appealing, inquiring about an early arrival might be a good idea.
When you check in, you have to provide your scheduling permit and a valid ID. The name on your ID must match that on your scheduling permit, so double-check that it does. You’ll be denied entry if the two names differ, or if your ID is expired. I also recommend printing multiple copies of your scheduling permit ahead of time to avoid technical glitches. You don’t want to find out that your phone or printer isn’t working the morning of your test.
- Remove your jewelry before you go
The testing centers at which Step 1 is administered have recently instituted a policy that bans all jewelry apart from wedding and engagement rings. Though it may seem like a silly consideration for test day, make sure you arrive at the test center with all jewelry removed ahead of time. Even though lockers are provided for personal items, you likely won’t want to leave valuables in there, and you won’t want to worry about whether your necklace is safe while taking Step 1. And for those of you who have piercings that are difficult to remove, making sure you can get your jewelry out before test day is a must. Some jewelry requires professional removal or pliers, neither of which will be available at your test center.
- Any clothing you wear into the test room must remain on your body
Because you can’t predict how warm or cold your test room will be, bringing layers to the test center is a good idea. But should you choose to wear a layer into the test room itself, you won’t be able to remove that layer until you decide to take a formal break. You are allowed to roll up your sleeves, but otherwise altering your outfit while testing is prohibited. The waiting room to the test center should give you a good idea of the temperature in the test room, and knowing whether you are generally warm or cold should help you gauge what to wear.
Wondering whether your location tends to run warm or cold? Read testing center reviews to find out.
- Wearing shirts and pants without pockets can make your check-ins and outs quicker
Each time you take a break and leave the test room, you have to formally present your ID and sign out with the test proctor. When you return, you will present your ID again, get wanded by a metal detector, have your pockets searched, and sign back in. The sign-in and out process is variable in length depending on how many students take a break at once, and it does detract from your overall break time. Though you can’t control how long the line to sign in or out will be, you can streamline the process by wearing clothing without pockets. This won’t buy you a ton of time, but it is one less step complicating your breaks.
- Noise-cancelling headphones are available at every station, as are headphones for sound
Some Step 1 questions feature a sound component for cardiac or pulmonary auscultation. Headphones are already set up at each station, so you should be able to pick them up and hear the sounds easily. Be sure to test your headphones during the tutorial time, however, as fixing a glitch will be easiest when the clock isn’t running down on one of your test blocks.
Additionally, noise-cancelling headphones are available at each station. They’re effective for blocking out the shuffling of other test-takers, but they can be hot and difficult to fit comfortably over your ears. You are allowed to bring soft earplugs with you into the test room, and I recommend having your own pair ready should the ones provided be inadequate.
- Come prepared with food, water, and any medications you might need
Adrenaline and anxiety can make for a sensitive stomach. Although I had experimented with different types of food on breaks in my practice tests, I still wasn’t sure what I’d want to eat on test day. I packed a lot of different foods—fruits, PB&Js, granola bars, yogurt—that I thought I could eat quickly and that wouldn’t make me queasier than I already was. In addition, my test center did not have a water fountain or vending machine, so I came prepared with enough liquid to stay hydrated all day. I also packed ibuprofen and antacids just in case a sour stomach or headache snuck up on me. I didn’t use a lot of what I brought, but having extra food, water, and emergency medications ensured that I could handle whatever bumps arose on test day.
- You have unrestricted locker access on breaks and you can bring study materials along—but you probably shouldn’t
By the time you sit for Step 1, your copy of First Aid feels like an extension of yourself and it might feel strange leaving it behind on test day. While cramming on breaks might sound appealing, giving your brain those precious few minutes of rest is likely more productive than trying to predict what will be covered in your next block. You’ve already prepared for Step 1— focus on getting to the bathroom, eating, drinking, and resting on breaks.
Locker size varies across test centers. My locker fit my backpack comfortably, but you should call ahead to see what size space you’ll be given on test day. You will have unrestricted access to your locker on all breaks, so be sure to leave anything you’ll need for the day in there while you test.
Want help choosing a testing center or have feedback on a recent experience? Visit Review2.com to read and leave reviews for testing centers across the country.
Cassie Kosarek, MD is a professional tutor with Varsity Tutors, a live learning platform that connects students with personalized instruction to accelerate academic achievement. She earned her Bachelor of Arts from Bryn Mawr College and was a member of the Class of 2021 at the Geisel School of Medicine at Dartmouth College.