Need to delay step 1 with a twist...

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Should be fine I studied for the MCAT in Punta Cana. Trick is to schedule a couple hours each day on vacation where you commit to studying. I would go for two hours after breakfast and study then enjoy the rest of the day
 
I wouldn't go. I wouldn't even consider it. You'll get a lot more vacations, but this is your only shot at the USMLE, and you're below your target. You're terrified, yet making plans about a vacation 1 week before your exam... that doesn't quite compute.

Given how you describe yourself, I doubt you'll manage the discipline to study through the vacation week. I can imagine those 7 days being wasted, plus a couple leading up to it for preparations etc, and another couple immediately following it as you try to dust off the vacation fatigue and get back into study mode. Since a significant portion of your prep is going to be cramming, taking days off of studying at this point could really backfire.
 
In my view, the only options you should be considering are:

1) keep your earlier exam date. Do the best you can. Take your vacation afterward.

OR

2) delay your exam. Don't go on vacation. Study hard and do the best you can.

Trying to do both is just crazy. You really think studying while you're on vacation with loved ones is going to do anything for you? It sounds like you'll stress out your loved ones, hate your vacation, and won't make any progress with your studies. Awful plan IMO
 
Seriously?
If I were at your place, I wouldn't go on a vacation 3 months before my exam even if I had already bought it's ticket worth a million dollars. Unless I had the option of delaying my exam for another 3 months, which I clearly see you don't have.
 
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