USMLE STEP Exam day Survival Guide: What to Bring and What to Expect

Here you are. 

After months of preparation, the big day finally came: The USMLE STEP Exam Day. 

It may sound too epic, but the USMLE test days somehow remind me of a gladiator entering the arena. 

Reflecting on my USMLE Step 1 and Step 2CK exam days, I remember many feelings, such as fear, excitement, panic, and, I must admit, too many stress-related gastric problems. 

But also, at the end of the day, relief as all the pressure came down. 

The truth is that USMLE preparation for Step 1 and Step 2CK is critical, but preparing for the exam day itself is paramount. 

As for any exam, regardless of how much you’ve studied, how you’ll deal with the stress, pressure, time management, and fatigue is what will truly determine your performance.

Since we fear most what we don’t know, it’s essential to take the time to understand what’s expected of you on test day, familiarize yourself with its organization, and implement effective strategies.

In this article, I’ll share my experience with the USMLE Test and provide you with my best advice and tips to help you handle it confidently and nail your exam. 

What To Expect

USMLE Exam Format

USMLE Step 1

The USMLE Step 1 exam is administered in 8 hours, divided into seven 60-minute blocks plus a minimum of 45 minutes of break time and a 15-minute optional tutorial.

USMLE STEP 1 Exam Structure

The number of questions per block may vary but will be at most 40.  

In other words, on test day, you’ll have to deal with 280 questions!

Quite a performance, if you ask me. 

Note that you may be able to take longer breaks if you finish a block of test questions or the optional tutorial before the time runs out.

In addition, most test-takers skip the tutorial to gain additional break time.  


Brace yourself. Step 2CK is coming.

If we’re talking about 8 hours of exam duration, now we’re talking about 9 hours of exam duration!  

USMLE STEP 2 Exam structure

The exam is divided into eight 60-minute blocks. Again, the number of questions per block will vary but will be at most 40, and the total number of items will not exceed 318.

As for the USMLE Step 1 exam, you’ll have 45 minutes break, plus an additional 15 minutes if you skip the tutorial, which most candidates do. 

Check-in and Security Procedures

You’ll find on USMLE official website all the details relative to the rules and procedures you must follow on your test day. 

Therefore, this section will quickly review the most important one you must remember.

  1. Big Brother is watching you. 

You will be watched by staff at the test center in person and through audio and video recordings. Any rules you break for the USMLE or the test center will be reported. 

  1. The body searches and unauthorized items 

You’ll be scanned for prohibited items when you exit and access the examination room. 

This includes emptying your pockets, turning them inside out to ensure you don’t have any prohibited items, and removing eyeglasses for visual inspection.  

No items are authorized inside the examination room except for the items the test center provides you. 

Note that jewelry isn’t allowed except for weddings and engagement rings. 

Religious headwear is subject to visual inspection only; therefore, you won’t have to remove it. 

  1. Time

Punctuality is key when taking a test.

You must arrive at least 30 minutes before your scheduled testing appointment. 

Coming after your appointment may result in not being admitted to the test, and you may have to pay a fee to reschedule your test.

I highly recommend you familiarize yourself with the test center location ahead of time, so you don’t get lost on the test day.

  1. The scheduling permit

You’ve probably heard the question, “If your house is on fire, what would you save?” 

Well, before a USMLE exam, the answer would probably be:  

Your scheduling permit!

To access the exam room, you must have a copy of your scheduling permit and a valid, unexpired government-issued photo ID on test day.

Acceptable forms of ID include a passport, driver’s license, national identity card, or any other unexpired government-issued ID. 

Testing environment

Before accessing the examination room,  you’ll be provided with laminated writing surfaces, markers, and earplugs. 

As shown on your scheduling permit, you’ll have to write your name and CIN on one of the laminated writing surfaces provided. The CIN is important; you must enter it on the computer to access the test. 

USMLE Step 1 and Step 2CK are computer-based exams. 

A staff member will show you to your station and give you all the information you need. 

Note that there will be other test-takers in the examination room. 

Therefore, consider using the earplug provided by the testing center if you’re sensitive to the noise. 

Test centers’ staff are friendly and comprehensive. Listen carefully to their explanation, and do not hesitate to ask questions if you have any. 

What to Bring

The only things I needed to have on test day were my scheduling permit and an acceptable form of ID. 

The test center will provide you with pens and paper. 

However, as you’ll spend a minimum of eight hours in the testing center, there are a fair number of necessary items that you’d better bring.

Snacks and Drinks

Your brain needs fuel to work at its best, and here are some options: 

  • Fruits such as apples, berries, or bananas
  • Vegetables such as carrot sticks
  • Nuts and seeds such as almonds or pumpkin seeds
  • Whole grain crackers or granola bars
  • Greek yogurt or cottage cheese
  • Hard-boiled eggs

Remember to drink water to stay hydrated. 

Most importantly, avoid foods high in sugar and caffeine, as they can cause a crash in energy levels later on and…

Don’t try foods you’ve never had before. 

Believe me, you may regret it,


Headaches are frequent on test days, especially during the second half of the day, so it may be helpful to bring some painkillers just in case. 

Some candidates might find it helpful to bring antacids or antispasmodics, as the stress might also cause digestive symptoms. 

This is not mandatory, but it might be better to anticipate such episodes while taking your exam.  


Choosing comfortable clothing that allows you to move freely and easily is essential. 

Avoid anything too tight or restrictive, and dress in layers if the room temperature is not to your liking.

However, keep in mind that some testing centers might not allow you to remove your jacket once you’re in the examination room. 

Time management

You’ll have a maximum one-hour break during the exam day that you’ll have to manage wisely. 

The timing at which you’ll take your breaks will depend on how many 60 minutes blocks you can do in a row, although I won’t recommend you do three blocks in a row, as it may be too straining for your brain. 

Taking a minimum of a 20-minute lunch break after you have done three or four blocks leaves you with 25- to 40 minutes of break time. 

You can decide to pause after each block or after doing two blocks, for example. 

Regardless of how you decide to manage your time, keep in mind that: 

  1. The fatigue is more pronounced while doing the last three blocks. 
  1. You’ll have to go through the security process every time you leave your seat, which may be time-consuming. Therefore, if you’re planning on taking just a five minutes pause between two blocks, you’d better stay where you are.

Preparing Mentally and Physically

Because USMLE Steps mean so much to IMGs who dream of pursuing a residency in the US, the pressure that comes with the exams is enormous.

Even the best USMLE preparation won’t be enough if you don’t have an effective test-taking strategy and, most importantly, know how to handle the stress of the exam. 

 To help you with that, here is some advice: 

  • Get a good night’s rest before the exam: I cannot tell how important this is, as sleep deprivation will alter your memory and concentration.
  • Do not study before the exam: This includes the day and night before, the exam day, and the breaks. Cramming before an exam is useless, as you won’t retain any information. In addition, it’ll leave you even more stressed and frustrated. 
  • Refrain from researching your answers: I know the temptation is big, but just don’t.  
  • Relax: Easier said than done, but do not leave the stress works against you and ruin all your efforts. Be confident; stay calm, and all the answers will come naturally to you. 

Before any exam, I personally like to watch movies, and my husband makes me listen to Rocky Balboa’s song.

But you can play a video game, spend time with family and friends, or work out. 

Remember, you’ve spent months studying and doing your best. 

Trust yourself, trust your preparation. Confidence is key; no matter the income, you can be proud of yourself. 

That’s the hallmark of winners. 

Frequently Asked Questions


USMLE exam days can be very challenging, as you’ll have to manage the pressure and the stress to perform well on the test. 

Understanding the test organization and preparing in advance is essential, as it will help you implement effective strategies to handle that day in the best way possible. 

Again, I’ll repeat this : 

Remember to bring the necessary materials, such as a valid ID and your scheduling permit, and arrive at the test location a minimum of 30 minutes before the exam starts.  

Follow the rules of the Prometric center you’ll test at, and listen carefully to the instructions. 

Don’t worry about break time, as it is more than enough if you manage it wisely and, most importantly, avoid negative thoughts, stay positive, and trust your preparation. 

I wish you all the best and good luck, folks! 

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