Test taking strategies for the USMLE STEP Exams 

A good test-taking strategy while preparing for the USMLE Steps exams makes the difference between average and stellar scores!

However, most test-takers are not familiar with how to approach USMLE Step exams. 

In fact, despite studying hard, doing a hundred flashcards, watching hours of videos, or maybe even doing the first pass of their Q-Bank, many candidates keep missing a lot of questions!  

If that is your case too, well, maybe it is time to reconsider how you approach questions!

USMLE exams are not just about how much you know but how you use that knowledge.

I like to compare it with cooking.  

You may have top-quality ingredients, but if you follow the wrong recipe, you will end up screwing the cake anyway!

In this article, I want to share my test-taking strategies to quickly and efficiently answer questions!

To do so, we will review together how to: 

  • Efficiently read a question stem.
  • Understand the question.
  • Select the appropriate answer. 

Sounds easy, isn’t it? 

if you know how to identify the pitfalls to be avoided relative to each of these elements. Which you will learn throughout this article! 

 Ready? Let’s dive in!

1) Learn how to efficiently read a question stem.

Imagine having a conversation with a neighbor. You are not really interested, maybe even thinking about what you will eat at dinner, and not really listening to what is said. 

Well, the exact same thing can happen while you are reading!  

Concentration is what makes you read efficiently.  

The challenge of USMLE Step exams is to maintain your concentration as you deal with hundreds of questions that can cover any patient’s information relative to:

  • Demographic
  • Past medical history
  • Social history
  • History of present illness (HPI)
  • Review of systems (ROS)
  • Physical examination
  • Workup labs
  • Imaging
  • Management
  • Interventions
  • Medications
  • Other data

In addition, the pressure of being timed might result in constantly taking a look at the remaining time, like the white rabbit in Alice in Wonderland, which impairs even more concentration. 

The end result is that you rush the reading, falsely thinking that you will go faster and, thus, miss the most relevant data and end up either: 

  1. Answer wrong
  2. Don’t have a clue about the answer, return to the vignette to read again what you have missed, and end up losing more time. 

The good news is that once you get aware of this vicious circle, you did half the job to get out of it.  

In conclusion, taking the time to read carefully and throughout the question stem is key as it will actually save you time and help you answer correctly! 

I know it’s challenging, but the more you get used to doing it, the faster and the better you will be.

2) Understand the question.

You might be surprised to know how many test-takers answer the wrong question. 

 Sounds improbable? Well, let me show you how this can happen. 

 A 57-year-old male is under evaluation for recurrent right lower lobe pneumonia.

Here we have the same vignette and the same answer options but slightly different questions that completely change the purpose of the inquiry. 

Whereas the answer to Question 1 is (A), as you are asked about the best next step to confirm the diagnosis, the answer to Question 2  is (D) since they asked about the best next step in the management algorithm. 

To illustrate even more, here is another of my infamous metaphor: 

Imagine being at the restaurant, ordering pancakes, and receiving waffles instead. Both are delicious and made of more or less the same ingredients, but still not the same. 

An answer option can be correct, but this doesn’t mean it answers the question you were asked for. 

Thus, to avoid this second pitfall, you must read the question stem carefully to determine precisely what you are asking for.  

3) Select the appropriate answer.

So, you have carefully read the question stem and understood it, and now it’s time to pick the correct answer!  

Based on my personal experience and those of my colleagues who took the USMLE exams, while selecting an option you either: 

  1. Know the response, thus selecting it directly.
  2. Don’t know the response, thus try to guess it.  

First, let me clarify that there is nothing wrong with an educated guess, as you don’t come up with an answer “by chance” but instead use your medical knowledge to eliminate the incorrect options. 

This implies that you know why the other options are incorrect to eliminate them. 

Let us see it works in a practical example!


Now let us confront the data with the answer options. 

 A) Does this patient suffer from an epidural hematoma? 

So, what do we know? Epidural hematoma is usually seen in young patients and occurs after significant trauma. 

This patient is 63-year-old, and nothing in the question stem refers to an accident, a fall, or any type of trauma.  

Therefore, the age and the circumstances make the diagnosis of epidural hematoma unlikely.

B) Does this patient suffer from hyperosmolar hyperglycemic syndrome (HHS)?

Again, what do we know? HHS is a frequent complication of type 2 diabetes. It tends to affect the elderly, who are more prone to dehydration, and its manifestations include fatigue, confusion, and nausea. 


This patient lacks the signs of dehydration such as hypotension, tachycardia, dry mouth, or frequent urination that present with HHS. 

Therefore, the absence of symptoms suggesting HHS makes this diagnosis unlikely. 

It’s crucial to pay attention to what is presented in the vignette and what is not mentioned to eliminate options properly. 

C) Does this patient have acute viral gastroenteritis? 

What do we know? Viral gastroenteritis is a self-limited disease that manifests with diarrhea and vomiting that usually lasts a day or two. 

Besides the lack of diarrhea and vomiting, this patient’s symptoms have been lasting for ten days.

Therefore, the presentation and duration of her symptoms make a diagnosis of acute viral gastroenteritis unlikely.

Interpreting the timeline correctly is key as it will help you select the correct option and eliminate the wrong ones. 

D) Does this patient have digoxin toxicity? 

As you probably already guessed, the patient in the vignette has digoxin toxicity caused by a medication interaction. The verapamil prescribed three weeks ago for managing atrial fibrillation increased the digoxin concentration, leading to her symptoms.  

4) Conclusion

Building solid medical knowledge is essential to take any of the USMLE exams. However, one must not underestimate the importance of developing good test-taking skills. 

A good test-taking strategy will help you approach any question and answer it correctly and rapidly, ultimately hugely impacting your score. 

Whether you start by reading the question stem or the question itself, it is crucial to: 

  1. Read the question stem, the question, and the answer options carefully. 
  2. Understand what the question asks you.
  3. Confront your medical knowledge to the answer options to identify the correct response.

For more tips, give a read to my guide for success on Exam day.

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