Episode 50: This is the first guest series lecture targeted for residents, but these “Test Day” strategies apply for the USMLE, MCAT, and every shelf exam you’ll ever take.


Test Taking Strategies For The Boards

The United States Medical Licensing Examinations, ABIM, and ABFM focus their content for the general, undifferentiated medical practitioner (GUMP).

Board exams are designed to separate out good from bad test takers. It is assumed that all are adequate clinicians. Study guides are better than reviewing recent literature (within the last 5 years).


Rule based questions are thrown out of the test development pruning process. The questions have to be answerable from information contained within the question. Therefore, you’ll be selecting the “single best answer” practically all the time. The diagnosis, treatment, or risk factors are always pulled directly from the question stem and are needed to jive with the correct answer.

Including images in the test is expensive and are, therefore, are very important for the correct answer. It may be a normal chest x-ray, but that information will be important in the thinking process required to arrive at the correct answer.

Questions That Don’t Count Towards Your Score

15% – 20% of your questions are being “tested” and aren’t being considered for your score. They are being live tested to see if the question is a discriminative question. That is, does everyone get it right or wrong? If so, it will be thrown out. This process takes about 1,5 – 2 years to vet questions in this way, so very recent articles CAN’T be included.

Repeated Questions

Almost 20% of the test is repeated annually. Therefore, read remembered questions and get extra points.

Anatomy of a Test Question

Question Stem

Most of it is unnecessary information.


The last sentence is the actual question.

Correct Answer

There is only one.


Incorrect answers often have some truth in them.

Putting all this together, if you get a question, look at the picture first. Then look at the Lead-In.

Look for magic words: (download the complete list of “magic words”)

  1. Ashkenazi Jews and Gaucher’s Disease
  2. “Plop” on auscultation – myxoma
  3. Tearing chest pain – dissection
  4. Pt. works with animals – Tularemia
  5. Demographics are always specific for the clinical pattern consistent with the correct answer.
  6. http://medical-mastermind-community.com/pre-med/usmle-step-1

Absolutes are “always” wrong

Words such as never, always, everyone, etc. These statements are way too broad to be true most of the time.

Time Management

  • Spend 1-2 minutes on a question. Don’t waste your time.
  • Save calculations for the end, unless you are very quick with 2×2 tables in biostatistics. If you recognize nothing, guess.
  • Half of the test will have to answers that you’ll think about. The good distracter is partially correct.

Examination Day Tips

  1. Wear layered clothing, so you can peel them off. Don’t get cold!
  2. Don’t study for 1-2 days before the test.
  3. Don’t study during the breaks.
  4. Get plenty of rest. No sedatives or alcohol. Stay up late 2 nights before so you can sleep well the night before the exam.
  5. Don’t change answers. It’s a 55-45% sway. Stick with your first gut instinct.

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