What to expect when taking the actual Step I

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Keyser112

Full Member
10+ Year Member
5+ Year Member
15+ Year Member
Joined
Dec 4, 2006
Messages
117
Reaction score
0
So I just finished the exam earlier today and thought I'd share some thoughts while things are still fresh.

If you aren't taking a practice exam at your centre then this first bit will be helpful to you:

When you arrive, you need your scheduling permit and a piece of photo ID with a signature. I brought two just in case but didn't need it.
You are then handed a sheet of paper with a list of rules, etc. It's just a formality. You get a small locker and can store all of your stuff in the locker. The only items you can bring into the exam room are your ID and your locker key.
You then register and they may or may not take your fingerprint (didn't take mine). They will take a photo ID of you. They will give you a markerboard, or markerboard-type paper, as well as a couple of dry erase markers. You need to put your name and CIN number on one of the markerboards - the CIN is on your scheduling permit, but they'll remind you of that when you are there.
You then sign into a log book and proceed to the exam room. *Every time you leave the exam room (breaks after blocks) you sign out, in the log book. When coming back from break, you sign in, in the log book.

So you are assigned a seat, and you can change it if you don't like where they put you. Once you are sat down at the computer, the proctor will make sure you have everything you need - headphones for the audio and headphone-earplugs.

You then click on the computer screen and it will prompt you to enter your CIN.

Once you do this, the clock begins ticking...

So this is the time breakdown.
7 blocks of 48 questions, and 1 hour to complete each block.
45 minutes break time.
15 minutes tutorial.

So that means, if you were to finish every block at the last second, you would have a total of 45 minutes break time throughout the exam. This INCLUDES any time you may want to eat lunch. So you basically have short breaks throughout the day.

Now, if you basically skip the entire tutorial, you can add that tutorial time to your total break time = 60 minutes of break time (45 minutes scheduled + 15 minutes added from skipping the tutorial).

**However, I would not just skip right through the tutorial. Make sure your headphones are working properly when the headphone tutorial page comes up. Mine weren't working, and the proctor had to run over and find some that worked... and the whole time the clock was ticking. So that was annoying but at least it didn't disrupt an actual question block.

After the tutorial, there is a screen with 2 boxes that read:

Proceed to the next block of questions?
and
Take a scheduled break?

Obviously you aren't going to take a break here so you click on the box that takes you into the actual exam. You now have 60 minutes to complete the first block of 48 questions. At 5 minutes, a warning message will come up on the screen saying you have 5 minutes left in the block.
The format of the exam is basically EXACTLY the same as USMLE world. So definitely familiarize yourself with the lab values tab, etc. I used it a lot more in the actual exam than I did when doing UWorld. Not for every single question or anything, but more often than UWorld. So make sure you know where things are on that tab - i.e. TSH values, WBC differentials, Urine creatinine, etc. etc.

*What is unique to this exam:
1) for the audio questions, you are able to actually move a stethoscope over a picture of a patient's chest. There are 3-5 areas of the chest with yellow circles that you can move the stethoscope to and you will hear different sounds based on the location you put it. Was cool, but it obviously made the question take longer.
2) there are video questions! I didn't have any, thank God, but there definitely are potentially video questions. In the tutorial, there was an example of a patient with Parkinson's displaying Parkinson's symptoms. So just don't be caught off guard if you get a video question.
--> so for either of these types of questions, you will a prompt at the beginning of the question saying "this has accompanying audio, etc" then have the regular question stem, then the answer choices below the question stem, then in the bottom right corner of the screen there will be a box that says "audio" or "video" or whatever. You can't miss it.

Ok, so now you've finished your first 48 questions. Yay that wasn't too horrible, and if it was, who cares, those are just the questions that don't count towards your actual score.

Now, you will select "End block" at the bottom of the screen. The computer will prompt you "are you sure" and you click "yes" to proceed or "return to question block" if you clicked that by accident. If you click "yes" you will again be taken to the screen that says:
Proceed to the next block of questions?
and
Take a scheduled break?


At this point you may take a scheduled break.
If you click "Take a scheduled break?" you will be taken to a screen that reads:
Total break time remaining: xxx
Total exam time remaining: xxx

You may now get up, and leave the exam room and sign out with the proctors to get some food, a drink, walk outside... whatever.

You can take as long or as short of a break as you want, but obviously don't take a 20 minute break since you may not leave yourself with anything later in the exam.

As an aside: When doing UWorld questions, I always had at least 10 minutes to spare after each block of 48. The most I ever had for the real USMLE Step I was 4 minutes. Four of the blocks I finished with like 30 seconds left. So don't assume you're going to be able to bank a ton of time cause when the real exam is on, you double, triple, and quadruple check your answers (or at least I do because I have OCD... or OCPD... or.... who the hell cares, I'm done )



Once you are done with your break, you sign back in again in the log book, and go back to your computer. You are then prompted to put in your CIN again, and once you have done that, you are taken to the next block of 48 questions.

Rinse and repeat until you are done all 7 blocks. And that's it!



Oh, then at the end there is some survey you can fill out that takes 5 minutes.



OK so now the stuff you guys want to hear: what was on the exam?

Quite honestly, it was DEFINITELY easier than UWorld. Like night and day. I'd say it was tougher than the Free 150 questions that you can do if you do a practice exam at your centre.. and probably about the same difficulty as the practice NBMEs.

I was considering pushing my exam date back 2 weeks but I'm glad I didn't. Using the resources I did (FA, UWorld, and Goljan) I wouldn't have done any better going over all of that again.

So what I 100000000% recommend, is in your last 10 days of studying, MAKE SURE you go over FA in its entirety. Like, know FA cold. Just like everyone says. I heard from upper termers to do this, and I did. And I'm VERY glad I did. So many questions I just flipped through FA in my mind and basically grabbed the answer right out of it. Like I can't emphasize enough: GO THROUGH IT.

One thing about this exam that I really liked was that it was, without question, the most fair and best written exam I have ever taken. Out of the 336 questions, there was only 1 I was slightly confused about. All of them were worded well otherwise.


OK breakdown:
**: know that chapter well, nothing crazy, but do know the stats questions. cause having to figure out the math through reason takes up too much time. so make sure you know PPV, 1-B, etc. just so you don't have to think about it if you get a question.

Embryo: FA is more than enough

Micro: FA is more than enough

Immuno: FA is more than enough

Pathology: FA and UWorld are essential

Pharm: FA is more than enough, and definitely focus on mechanism, side effects, drug interactions. Uses were less yield, but still important. i.e. I had a question on malignant HTN and it asked which drug to use. I had a question with a pt who had an anthrax infection and it asked which antimicrobial to use.

Anatomy: make sure you know the nerve distributions in the shoulder/arm/hand. Dermatomes are important too. I had some randoms involving the leg and origin/insertion questions. meh, close eyes and guess.. haha

hmm what other subjects are there?

Psychiatry: FA is more than enough

Neuro: look through a neuro atlast for brainstem, medulla, midbrain slices and look at where the tracts are that go through each area. FA covered the spinal cord well.

And I think that's it? Oh physio: FA is prob all you need.


So ya, look at all of that. FA is definitely $ in the bank. The questions I didn't know were questions I wasn't going to get no matter what I studied, unless I used my old class notes, so I wasn't too worried about those since I don't think most ppl would have studied that stuff
i.e. what are the layers that cover the ureter and bladder and something about putting a needle through it and which structures would you hit/ they were all random things, i dont' remember it exactly, but i was like ***??


Um, so ya. I think that's about it.


The key to success here is to maintain mental focus. Constantly remind yourself to keep it together. Remind yourself that you've been studying for 2 years and you aren't going to lose focus now.

The beginning you are nervous, the end you are drained. Be prepared to feel this way so that you can know how to overcome it when it happens.

so ya! good luck to you guys, let me know if you have any specific questions!


Keyser

Members don't see this ad.
 
Members don't see this ad :)
I have one more question... what about food? I took a practice test and they said no food allowed, which would make it very difficult to eat without wasting a lot of time. Were you able to keep a snack in your locker?
 
Thanks for the post, man. This was something I was looking for, and you wrote it out step-by-step for a fellow OCD med. student like myself. When you have time, I would also like to know the answers to the questions the two people above me asked: (1) if you finish early, do the extra minutes get added to your total break time, (2) what's the policy with food or does it depend on your location? Thanks again!!
 
Go out/Watch a movie/Smoke your stash/Make love to something, you deserve it.

If you remember something tomorrow, please add it!
 
Awesome post, thanks! If you finish a section with 5 minutes remaining, let's say, is that 5 minutes added to your break time?

yes it is.
so, for example. let's say you start your exam with 60 minutes of break time (you finished the tutorial immediatly, therefore have 45 minutes of regular break plus the 15 minutes of added break since you breezed through the tutorial), then if you finished your first block of questions in 55 minutes, you would now have 65 mintues of break time.

if, in your second block, you finished that in 30 minutes (lol), then you would have:
65 minutes (if you didn't use any of your previous break minutes) + 30 minutes (from the time you didn't use in your question block) = 95 minutes
 
Last edited:
I have one more question... what about food? I took a practice test and they said no food allowed, which would make it very difficult to eat without wasting a lot of time. Were you able to keep a snack in your locker?
you are not allowed to bring anything with you into the actual exam except your ID and locker key.

this is what I did:

I brought a container with yogurt and a ton of frozen fruit in it (fruit thaws out over the day and keeps yogurt cool) as well as whey protein in the mixture.
I also had Gatorade and bananas
This was basically what I ate the entire day. Why? Because the Gatorade keeps you hydrated without having to pee all the time, and the food keeps your energy up without a sugar crash (chocoloate/candy bars) or overeating tiredness (huge lunch).
So my protein + good sugars + good fat seemed like a good combination.

And yes you can keep whatever you want in your locker
 
Gatorade is perfect = hydrates without making you want to pee (the hydration cancels out the sodium content?) and electrolytes.
 
hi, keyser112,

i have a question. say, if you ran out of time on a block (after the 60 minutes), would the next block of questions automatically come up? or would you still need to press a button that says "proceed to next block"? would you still be able to take a break when the time is up for a particular block?

ooh, i have another question that i asked somewhere else, but he didn't reply. =P how did you spread out your breaks? (i.e. block1-break-block2-break..etc). thanks so much for your post! it really makes it less nerve-wrecking studying for the boards, when you know the logistics ahead of time. :)
 
hi, keyser112,

i have a question. say, if you ran out of time on a block (after the 60 minutes), would the next block of questions automatically come up? or would you still need to press a button that says "proceed to next block"? would you still be able to take a break when the time is up for a particular block?

ooh, i have another question that i asked somewhere else, but he didn't reply. =P how did you spread out your breaks? (i.e. block1-break-block2-break..etc). thanks so much for your post! it really makes it less nerve-wrecking studying for the boards, when you know the logistics ahead of time. :)

If you run out of time on a block, it will take you immediately to the page that says "Proceed to next block?" or "Take a scheduled break?" so it's basically the same as usual.

Personally, I took a break after each block. No one else in my test centre did, but that's their decision.

I came into each block feeling (somewhat) refreshed and ready to go. I personally would never recommend someone going 2+ blocks in a row without a break.

And you are welcome. I made this post (here and on the Valuemd forums) for this very reason (bolded text). I didn't have a good idea of what I was getting into until I actually did it. I wanted to help prepare my fellow med students so that they could be that much more prepared.
 
since you just took your exam (and it's still early in the beginning of the year), did you use FA 2009 or 2010? just wondering :)

you are a great person, keyser112. we can just sense it. :)
 
Members don't see this ad :)
since you just took your exam (and it's still early in the beginning of the year), did you use FA 2009 or 2010? just wondering :)

you are a great person, keyser112. we can just sense it. :)

thanks :)

FA 2010. I have read through most of 2009, but I'd definitely recommend 2010.

... However it's pathetic that 2010 still has numerous errors in it. Like, it's an fortunate joke that FA still has so many errors.

i.e. I was reading the review pages yesterday and there was some renal high yield that was completely incorrect. I thought that maybe I was the one that was going crazy until I looked it up.... IN FIRST AID and realized that it was just the "high yield" facts that were incorrect.
 
:thumbup:

i think this may be one of the most detailed posts about actual exam day experience, including testing center, conditions, etc. these are all things i've wondered and im sure others have too. thanks for an excellent post.
 
you are not allowed to bring anything with you into the actual exam except your ID and locker key.

this is what I did:

I brought a container with yogurt and a ton of frozen fruit in it (fruit thaws out over the day and keeps yogurt cool) as well as whey protein in the mixture.
I also had Gatorade and bananas
This was basically what I ate the entire day. Why? Because the Gatorade keeps you hydrated without having to pee all the time, and the food keeps your energy up without a sugar crash (chocoloate/candy bars) or overeating tiredness (huge lunch).
So my protein + good sugars + good fat seemed like a good combination.

And yes you can keep whatever you want in your locker


Sounds like a good plan. Should've clarified - they said no food in the building, which I'm hoping was just to keep us from eating in the hallway and not in the waiting room of the test center. Here goes nothing.
 
you are not allowed to bring anything with you into the actual exam except your ID and locker key.

this is what I did:

I brought a container with yogurt and a ton of frozen fruit in it (fruit thaws out over the day and keeps yogurt cool) as well as whey protein in the mixture.
I also had Gatorade and bananas
This was basically what I ate the entire day. Why? Because the Gatorade keeps you hydrated without having to pee all the time, and the food keeps your energy up without a sugar crash (chocoloate/candy bars) or overeating tiredness (huge lunch).
So my protein + good sugars + good fat seemed like a good combination.

And yes you can keep whatever you want in your locker


Thanks for your post and also for telling us about your food choices. Very healthy, well planned! Hope you get an awesome score back.
 
Was biochem good enough from FA?

Wud u say that FA covered atleast 90% of the exam if not more?

and wt did you do about the pictures and heart sounds?
 
I forgot to add biochemistry.
First Aid was definitely enough. USMLE World helped to clarify a lot of the clinical aspects of what we should focus on, so FA + UWorld was the best strategy in my opinion.
 
During you break time can you leave the testing center, or are you confined to the breakroom? My center is in a downtown area and I'm thinking of grabbing something hot for lunch. My stomach doesn't handle cold meals too well.
 
hey wt did u do for the pictures--ct scans--cross sections..angiograms? fa?

and wt about the heart murmers?
 
Gatorade is perfect = hydrates without making you want to pee (the hydration cancels out the sodium content?) and electrolytes.

Isn't gatorade suppose to be approximately isotonic? Wouldn't that just extend your extracellular fluid, resulting in more filtration and urination?

Trying to find the best drink plus incorporating physio with this question...
 
Isn't gatorade suppose to be approximately isotonic? Wouldn't that just extend your extracellular fluid, resulting in more filtration and urination?

Trying to find the best drink plus incorporating physio with this question...

If you're going to look at your test day drink from a renal phys standpoint i don't know what you expect to do. I guess you'd want a hypertonic drink to decrease any chance of ADH being stimulated by low osmolarity... or actually better yet why not just drink absolutely nothing the day before and morning that way you're dehydrated and you've kicked up your RAA/SNS.... Relax, you'll have break time to use the bathroom. Anything like water, soda, coffee, tea will clearly be worse than gatorade in terms of making you need to go. The whole point is that most drinks aren't even isotonic and you just need something to replace what you've lost.
 
Amateurs. I cath'd myself in the bathroom before the MCAT.

I thought about giving myself a colostomy but I just didn't have the guts.
 
During you break time can you leave the testing center, or are you confined to the breakroom? My center is in a downtown area and I'm thinking of grabbing something hot for lunch. My stomach doesn't handle cold meals too well.
You can go wherever you want. Just don't use up your break time or your test will automatically resume and the clock will be ticking whether you are there or not.
hey wt did u do for the pictures--ct scans--cross sections..angiograms? fa?

and wt about the heart murmers?

I didn't do enough for these things. First Aid was all I used. I'd recommend a neuro atlas for head stuff. FA covers everything else.

For murmurs there are some good websites that have heart sounds on them. Too lazy to find the links but do a search and you'll find them.
 
Thanks for this post Keyser112, I was just about to post a thread with this exact question. Thankfully I did a search. Good to know the computer tracks your break time. Thanks for the tip about the headphones as well.

My question is, are you absolutely not allowed to bring anything into the exam room? So are we able to scribble our thoughts or anything? Is that what the marker and markerboard like paper is for?

Did you have a physical calculator?

Thanks.
 
Thanks for this post Keyser112, I was just about to post a thread with this exact question. Thankfully I did a search. Good to know the computer tracks your break time. Thanks for the tip about the headphones as well.

My question is, are you absolutely not allowed to bring anything into the exam room? So are we able to scribble our thoughts or anything? Is that what the marker and markerboard like paper is for?

Did you have a physical calculator?

Thanks.

The only thing you can have is your license, your locker key (that they give you) and foam ear plugs. You will have to empty your pockets everytime you enter the room to prove it. You get a little mini calculator in the FRED software (just like in UW/Qbank)

You can do whatever you want with the laminated paper.
 
thanks for the advice!!! I always have to pee between each block.. people better not get in my way lol.


And i'll be pissed as hell (no pun intended) if they dont let me bring food, I'm gonna call and ask sometime next week. also, does anyone have the link on hand to print out the USMLE certification thingy.. being so wound up in studying, I totally overlooked that part
 
Last edited:
thanks for the advice!!! I always have to pee between each block.. people better not get in my way lol.


And i'll be pissed as hell (no pun intended) if they dont let me bring food, I'm gonna call and ask sometime next week. also, does anyone have the link on hand to print out the USMLE certification thingy.. being so wound up in studying, I totally overlooked that part

https://apps.nbme.org/ciw2/prod/jsp/login.jsp
 
Top