Give Me A Break! Step 1 Time Management

By Patrick Sylvester

Let’s talk about your plan for exam day. You might be thinking, “Surely there are more important things I should be studying/worrying about?” Well you might be right, but in my experience, too many students put off thinking about test day logistics until the bitter end. As part of our series of posts on test-taking strategies, I’d like to take a moment to discuss how break time works for the USMLE Step 1 and how you might maximize this time on that long-awaited day.

From the 2014 USMLE Bulletin of Information, you will learn that you will be provided with 45 minutes of total break time to be used during authorized breaks (AKA at any point between blocks of questions). For the USMLE Step 1, with its 7 blocks of 46 questions, that means you have 6 opportunities to use your total break time. It is important to note that if you elect to skip the 15-minute tutorial or finish a block of questions early, this time will be added to your break time. Given that most people opt to skip the break due to their familiarity with the FredV2 interface (which is well-replicated by most of the popular question banks), this means you have up to 60 minutes of time to use as breaks between sections.

What can you do with this time? Well, that’s the beauty of it—anything you want! You can plan your schedule to use all this time at once (maybe grab a big lunch or nap) or perhaps allow a number of short breaks to use the restroom, get some water or a quick snack, or even do some light reading. Actually, don’t do that last thing. In my opinion, the best thing you can do is relax and decompress between blocks so that you can get back into the game refreshed and ready to go. Regardless of how you schedule your breaks or what you chose to do during that time, you ought to be cognizant of the fact that due to the process of checking in and out of the exam your time will be less than expected (in fact, you should plan to lose about 2-3 minutes for each break).

What happens if you inadvertently use more break time than you should? Well, according to the USMLE Bulletin, any excess time will be subtracted from the time allowed for your last block of questions. Therefore make sure that you are aware of how much time you use. Luckily, you will be provided with a “time summary” feature, which will help you keep track of the total test-day time and how much time remains allotted for breaks.

With regard to the timing of your authorized breaks, it is my personal recommendation to create a strategy a head of time. Here’s mine (or rather a graphical representation of my plan):

Give Me A Break - Time Management on Step 1
A couple of clarifications/comments:
• I had taken approximately 5-10 minutes during the tutorial to get adjusted to my surroundings and decompress. I also used this time to jot down a few notes that I felt would fall out of my head otherwise (stay tuned for a post regarding these “whiteboard” topics). Therefore, I had planned to use 50 minutes of break time to use across the day.
• I was fairly well accustomed to doing multiple blocks of questions in a row based upon my experiences with the NBME practice exams. However, I knew that after a while, I would start to get a bit weary-eyed. Hence, I chose to multiple sets of blocks together early on, and space them out later on.


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