So, here's my experience, hope it helps some one. I passed this year on the third try. As background, I've always had significant issues with test anxiety since highschool, but always compensated by studying harder and longer; did med school and residency at large academic centers in US. Did a chief residency year and got into heme/onc fellowship at a large academic center. My first year taking the test, I took Awesome Board Review. I had studied on and off from MKSAP before taking the course, but had not ready all the MKSAP books. I read the ABR books twice, some sections more than twice and did all of MKSAP. My final average on the MKSAP was 80%. I studied for total of about 4 months. I failed the test by about 15 points. Second time I took the test, again, read ABR books three times. Did all of MKSAP questions twice. Final overall score on MKSAP was 99%. Overall study time about 6 months (after work, all weekends). I took the test while in fellowship, but felt that I had enough time to study. Had significant anxiety, but felt good coming out of the exam. Failed the test by about 10 points.
This last time, I talked to one of my friends who had also failed twice, and was in a good fellowship program, had just gotten an attending job and passed the exam on her third try as well. She recommended switching gears and doing MedStudy. I did MedStudy books and videos. I took notes, made flashcards, studied my behind off. I started heavy duty studying in November 2014, starting with sections I had done the worst on the previous year. Took a month off in February due to a health issue and picked back up heavy duty studying in March 2015. Did almost all of MedStudy questions. Read and re-read all answers and explanations, especially for the questions I got wrong. Watched the videos after I had read the books twice and taken notes. Took notes off of videos. I booked a room in the library and took a full length practice test offered by MedStudy and got 82% on it, about two weeks before the test. Reviewed sections that I didn't do as well on. Was very careful to try to not make stupid mistakes during the actual test in terms of reading all the questions and answer choices and not answering questions hastily. Felt good about the test, but I had been so traumatized by the previous two years that I was nervous as can be until scores came out today.
Having said all of that, I also saw a therapist, one who worked with people who specifically had test taking anxiety. I saw him every couple of weeks throughout the year. The relaxation and visualization methods he taught me were absolutely invaluable (no medications of any kind involved whatsoever). I mention this, because I know it's not some thing that most people want to talk about, but there is a lot of smart people out there who work hard and study hard, but don't do well on tests and I don't think at our level (residents, fellows) this is some thing that is addressed or talked about at all.
My advice: Take the test seriously, don't listen to people who say, "oh I studied two months and barely read any thing and only did questions, etc... and did fine". That maybe fine for some people, but for most, this test takes a lot of study-time and hard work, regardless of how well you did on your ITE during residency. If you've had issues with test anxiety, please do not brush them aside, get help, talk to some one, it may be the thing that makes the difference for you. And, finally, if you've failed the test before, I know, it sucks, I've been there, but do not despair. Take a deep breath, read this forum, talk to friends and see what you need to change in your study method and then hit the ground running once you've gotten over the initial shock of having failed. This is an important test from a professional/practical stand point (getting a job, etc...) but it does not define you as a physician or how good or competent you are. You can do this and forums like this can help.