Just took the beast today. Here's my breakdown of test day for anyone interested:
Let me start by saying my testing center was busy as hell. In my room there were about 20 people all taking different tests and they were constantly coming and going making lots of noise. Chairs were squeaking, people were coughing, at one point had some guy talking really loudly and the proctor wouldn't shut him up. It really threw me for a curve at first because I had done all my practice tests in complete silence. Also, signing out/scanning in/getting stuff from your locker takes a long time so if you're planning to go out and scarf down some food and be back in 5 minutes, it's probably not going to happen. Plus, sometimes the staff was busy helping someone else check in and I had to wait which was really annoying. Also, the bathroom at my testing center was a 1-2 minute walk alone and it was confusing to get to so I'm glad I went early to figure out where it was. I recommend doing the same.
Okay, now for the test. Oh. My. God. It was HARD. I think on the first block I marked 5 out of my first 10 questions which got me to panic a little right from the start. After that I settled into a groove but on every block I marked around 10-15 questions (compared to NBMEs where I'd generally mark 5-10). The difficulty level was around an average UWorld block, maybe sliiiiiightly easier, but much harder than NBMEs 15-17 (I cannot comment on 18 since I did not take it).
I'd say break down per block was around:
5-10 gimmes - straight forward classic presentation, easy points if you know FA relatively well
10-15 moderate questions - these require thinking and are initially difficult when reading the question but (most) become fairly straight forward when you catch on to what they are asking for (which can be a challenge in itself sometimes). For example I had a lot of graph interpretation stuff that looked really scary at first but then once you really get down to it was just application of a simple concept, so try not to get intimidated by these
10-15 difficult questions - vague patient presentation with no buzzwords or specific findings to clue you into any specific pathology, convoluted cardio/resp physiology questions (my weakness), micro questions with seemingly more than 1 correct answer (I guess one of them is "more correct"), etc.; I was stuck between 2 answer choices very often due to the ambiguity of certain questions and had to make a guess. These are the questions that just eat at you because you know you're probably missing something hidden in the question to push you to one answer but just can't figure out what. Probably the most important questions that separate the 220s/230s from the 250s/260s.
2-5 or so WTF questions - Basically, there were a lot of WTF questions. There were pathologies I hadn't seen before. There were anatomy q's with structures I hadn't seen since 1st year anatomy. Obviously can't go too much into detail but had a couple, umm, let's say interesting epidemiology questions that I guess I could have prepared for by browsing wikipedia and memorizing random trivia throughout medical school? I don't feel too bad about missing these because everyone is going to be feeling the same way.
I'm just glad to be done though. I know most people feel awful after they take it and I'm no exception. I was originally aiming for 240 but I will be ecstatic with a 230+ now. Good luck everyone.
