I too had an issue with time throughout med school and on step I and the first of my shelf exams. I took all three of the USMLE practice tests and would say that the timing is fairly consistent between the two. Same goes for USMLE world. I didn't have an issue with timing with either of the the practice tests or world. On the real test I usually finished with at least 10 minutes left to go back and review questions, however as the day wore on it got more and more difficult as I got tired.. Near the end I was finishing right as time was expiring. Bottom line- and this is huge- give yourself a minute on each question- if you are absolutely clueless at first glimpse, guess and mark it. You can then move quickly to the next question. To do well on the test you need to make sure you give yourself the time you need to get the gimmee questions and those you know right. If you give yourself 1 minute per question, you will then have 15 whole minutes to go back and review those you didnt know well and had marked. Practice whatever strategy works for you when you do your practice questions. If you want just do 46 question blocks to pace. If you get bogged down for like 4-5 minutes on only 5 questions, you almost have used up half your entire time on questions that you probably got wrong. Why not guess on these few and take the 20 minutes to get the questions you know right?
You will do fine. Just practice your strategy.
