Its the SAME test, just instead of being broken up into 4 parts its all conjumbled into 1 and of course the testlets. I prefered having it broken up, I always hated having 100 of the same thing in a row. From my own experience (took it ~3 wks ago and got a 92) the questions were very similiar to the old tests, I had ~25% repeat questions (or a slight variation). What makes it so hard to score in the 90's is the calibration, i.e. I averaged ~86 questions correct per 100. There were NO pictures and NONE of those questions that have the: a) 1,2,3 b) 1,3,5 c) 1,4,6 etc... type answer choices. It was straightforward, there were statements followed by 5 answer choices. The testlets were a little tougher but just required you to read a brief history of the patient and maybe a sentence or two and then answer 6 or 7 kind of related questions.
My advise: spend less time bitching about the "harder exam" and spend more time studying, its the same test you just have to get more right to score higher. and do NOT pm me asking me to tell you specific questions or what you should "focus" on... that's cheating.
What I did: studied decks 3-4 X's (pulling out the cards I knew as I went along to save time), reviewed all the exams i could find and then went thru all the questions i guessed on/missed, reviewed the First Aid book for the USMLE step1 (but limited it to Immunology, biochem, and microbiology) and also went thru the First Aid for the NBDE (which was ok, not that great). Big KEYS: USE MNEMONICS, especially for biochem cycles, artery branches, anatomy, and remember REPETITION is the key to Recollection.
Good luck and study hard