Doing practice questions is essential in your preparation for taking a multiple-choice exam. However, your goal should is not to “test” yourself, but to learn good question answering habits. As you do questions, yes, check whether you got them right, but more importantly, look at why you got the question right or wrong. Did you not know the content? Then that’s your cue that more study is needed. Did you misread the question? Then evaluate how you misread it and learn how the question writer wants you to read it.

When you do your practice questions, do them under a time limit similar to the actual exam. In general, your practice rule should be one minute per question. This is a little less time than you will have during the real exam. But a tighter interval will get you used to the time constraint. The ticking clock is one of the unchangeable realities of the USMLE.

To identify specific question answering bad habits, try this exercise. Select a set of 50 questions from a good questions source. These should be questions that you have never looked at before. Then, set a clock for 1 hour, and do the questions. Read them and answer them, but stay within the 1 hour time limit.  When the hour is up, do not score the questions. Instead, without a clock, go through and do them again. This second time, take as much time as you need — linger and reflect. When you have completed all 50 questions the second time, now look at the answers and score yourself. You probably got more questions correct from the second, untimed pass than you did the first, timed pass. With this data in front of you, you can now identify particular question answering problems that you have.

If you got a question correct on the untimed pass, but incorrect under time pressure, the issue can not be a lack of knowledge, rather you must have processed the question incorrectly. By examining these questions, the ones you got right the second pass, but missed the first time, you should be able to identify certain mistakes you are prone to making when answering questions under time pressure. Note what these mistakes are, and then think about what to do so you can correct this problem. If you know the content, but can not demonstrate it on the exam question, you get the same score as if you do not know the content at all! Spend time learning your most common mistakes, and then with this awareness, set up an approach to questions that avoids these common mistakes.

In addition to this self-diagnostic exercise, avoid these common mistakes when doing practice questions:

a.) Do not just do questions without preparatory studying. Review material first until you feel you know it, and then use questions to test yourself. Learning the answers to hundreds of questions that you may not see on the exam will not help you prepare. If you study by doing questions before you are ready, you will erode your self-confidence and fail to develop key linkages within the material.

b.) Do not get into the habit of lingering over a question or thinking about it for an extended period of time. You do not have this luxury on the real exam. Remember that you have just over one minute per question. You should spend about 75% of that time reading and analyzing the question stem, and the other 25% selecting an answer. Be honest when you do not know an answer; move on, and look it up when you are finished.

c.) So-called “retired questions” and many published questions in review books are not representative of questions featured on the current USMLE Step 1. They are a reasonable way to review content, but often do not reflect the length or form of the questions on the current exam. Kaplan Medical practice exams are your best sample of true USMLE-type questions.

d.) Do not do questions individually. Do them in clusters under time pressure, with 5 to 10 as a minimum. This will get you used to moving from question to question. Do not look up answers after each question. Instead, check yourself after you have done the full set of questions.

e.) When you start working on questions, do not panic if you do not get the correct answers. Learn from your mistakes. Questions are a part of the study process; they help you see what else you need to learn. You will get better at questions as your studying continues.

Answering questions is a game. To do well at this game you must identify needed skills and then practice those skills. Time spent learning to do question correctly allows you to demonstrate the level of knowledge you have and avoid the frustration of a score that is below your abilities.

Steven R. Daugherty, Ph.D.

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