My plan was to do all the questions straight through. Remaining time will automatically be added to your break time if you finish early.
There are 8 hours to finish seven, 1-hour long sections. There are two timers – one for the current section and another with the overall day timing. My advice is to focus on First Aid and do thousands of questions (UWorld + NBMEs first). Between First Aid and UWorld alone, the exam was manageable however, Goljan’s high yields definitely helped me on a few questions, and some questions were very reminiscent of the NBMEs I completed. In preparation for Step 1, I used First Aid, USMLE World Question bank, NBMEs 1-7 + any questions people posted on forums, BRS Physio, chapters 1-7 of Robbins, and good ‘ol Papi Goljan.
I had 5-6 questions which required headphones (heart auscultation) and less than ten questions which required calculations (mostly epidemiology). There were some epidemiological graphs which I had difficulty interpreting, but the radiographic images, gross specimens, and path slides were fair. The test had more immunology and musculoskeletal than I was expecting but less biochemistry. The rest were standard, NBME-type questions. A handful were topics I had never reviewed in detail (the specific constituents of the P450 system… like CYP3A4). USMLE Step 1 has 322 multiple choice questions – I would say about 1/3rd were “gimmies” (straight from First Aid, Goljan, and UWorld). Why my brain chose to sacrifice precious sleep the night before this exam is beyond me. It’s like I was consciously consolidating information my heart was racing and I had a horrible headache. After midnight, my mind was racing with everything I learned over the last few weeks. The night before the exam, I slept a total of 2-3 hours.
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