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7 USMLE Step 1 Exam Day Mistakes You Don’t Know You’re Making in Medical School & Tips To Improve Your Score

usmle mistakes

It’s the day before the United States Medical Licensing Examination (USMLE) Step 1 exam, and your stress level is at an all-time high. You’ve spent the past two years as a medical student learning high-yield medical topics and basic science details and here you are, the days before USMLE Step 1 exam day, and you feel like your mind is going blank.

There’s no way you’ll be able to get a full night of sleep! You’re nauseated, dehydrated, unfocused, and unconfident.

The more nervous you are, you increase your chances of making a Step 1 exam prep mistake you could easily avoid.

Students tend to make mistakes in their preparation or study regimes in the weeks or days before Step 1, which can hinder their performance, costing crucial points. Medical students aren’t an exception to these common errors; in fact, they’re often the example. 

Before we dive into the seven Step 1 exam day mistakes we can prevent, we do have a little study advice. If you’re weeks out from the Step 1 exam, we have a USMLE Step 1 study system you need to know about.

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Combining this three-step system of quiz, review, and repeat, with the healthy USMLE Step 1 habits you developed as an MS1 and MS2 are the best way to set yourself up for success.


Step 1 is arguably the most important exam in medical education in the United States. Your performance will help determine which residency program you will match to, and every single point counts on the big day. So what bad practices should you cut out of your routine to ensure your best performance on USMLE exam day? Even though
scoring for the USMLE Step 1 is pass/fail, it’s still important to set yourself up for achieving your dream score on Step 1 so you can sail through exam day and put your mind at ease.

Apply This Advice to USEMLE Step 2 CK and Step 3

While we are focused on Step 1, our study advice also applies to Step 2 CK and Step 3 — other United States medical licensing exams provided by the National Board of Medical Examiners.  Though, if you takek this USMLE Step 1 exam day advice, you’ll be an exam-taking expert (and won’t need this article!).

7 Totally Avoidable USMLE Step 1 Exam Day Mistakes (And How to Avoid Making Them)

Not Sleeping Enough

Mistake 1: Not sleeping enough, and not on a regular sleep schedule (napping, sleeping in on exam day)

This first mistake is so easy to avoid, that you can literally do it in your sleep (bad pun). You should aim for seven full hours of sleep each night during the week before your Step 1 exam, so you’re fully charged on the big day. Sometimes it seems like the solution to gaining more study time is sleeping less at night, or taking more naps during the day. Research shows this is far from the truth.

Sleep is important throughout your entire study schedule because your circadian rhythms (which influence your sleep-wake cycles, hormone releases, and other bodily functions) can take a few days to set into a rhythm. Don’t wait until the day before the exam to make the switch to a healthy sleep schedule.

If Step 1 begins at 7 am and you normally wake up at 10 am, start setting your alarm an hour earlier every day and going to bed an hour earlier every night. This will ease you into the practice of waking up at least an hour early to be alert and focused by 7 am. Check out our other tips for getting good sleep during medical school here.

Cramming for the USMLE Step 1
Mistake 2: Cramming the days leading up to the USMLE Step 1 exam

Ask any marathon trainer if you should run a marathon the day before your event, and they’re going to give you the same answer: you’re crazy. Training is all about being ready, not being done. Attempting to cram in all the medical knowledge you didn’t learn earlier the day before Step 1 is just a crazy notion. The best scores are a result of careful, planned, and sustained prep for Step 1 begininning on day one of medical school.

If you’ve been studying 14 hours a day for weeks, start to taper down to 10 hours a day, then to 8 (which is the approximate length of Step 1). Cramming increases your anxiety levels, and it’s more important than the time you spend studying is effective.

Research shows that studying the day before the exam hurts you because it crowds your short-term memory with last-minute info that can interfere with long-term memory retrial or bias your decision-making skills.

For example, if you study diabetes the day before the exam, your mind is naturally going to lean towards diabetes-related answers. Moral of this story: take a full day off to give your brain a break and don’t cram!



Locking Yourself Indoors
Mistake 3: Locking yourself indoors

Just because your career depends on the Step 1 exam doesn’t mean you should lock yourself in the library for weeks straight. Get out!

Start partaking in some light exercise in the morning. You don’t want to rigorously exercise at the risk of building up lactic acid, but increasing your heart rate with aerobic exercise is advantageous. This will release endorphins, giving you a better perspective and more confidence. Plus, it’ll help you sleep better at night. Try walking, light jogging, cycling, or hiking.

Try to spend a little more time outside during your study routine as well. You’ve probably been staring at your book or computer or tablet for weeks now, so give your eyes a breather! Find an open space where you can enjoy the view and allow your mind to relax for a bit.


Avoiding Television
Mistake 4: Avoiding all television

As a demonstration of your determination and willpower, you may have already given up television throughout the duration of your studying. Good for you—almost.

It’s great to practice focus, but sometimes you need to take a little “me” time. If you enjoy watching television typically, don’t deprive yourself of a reward from time to time. Some students even find that watching a movie before test day is a nice mental break.

However, you don’t want to watch a movie that will be too intense or cause a lot of reflection afterward. TV shows or movies with crashing cars, dying soldiers, or confusing love triangles may linger in your mind the day after you watch it, so leave those selections out. If you’re going to watch TV, pick something mindless.

Coffee for USMLE Step 1
Mistake 5: Over-caffeinating before, during, and after Step 1

usmle step 1 avoid coffee

A lot of students make the mistake of loading up on coffee and Red Bull right before heading into the Step 1 exam to stay as alert as humanly possible. Big mistake!

Some students might think that caffeine on exam day might hinder their performance, so they avoid it on the big day. Another mistake!

The truth is, you should take it easy on the caffeine altogether. Try to taper off your caffeine intake—or at least maintain your average—in the days leading up to the exam to avoid any symptoms associated with caffeine withdrawal.

And whatever you do, don’t increase your intake on the day of. You shouldn’t be making any drastic changes to your diet before the exam.

Another caffeine tip: Avoid caffeine after 4 pm so it doesn’t interfere with your sleep regimen.

USMLE Step 1 Test Day

Mistake 6: Avoiding thinking about USMLE Step 1 test day

In a fit of denial, you might be tempted to avoid thinking about the “day of” altogether. But don’t forget about your test day preparation!

Preparing for the test day is a great way to boost your confidence and mental readiness. Plan out the day:

  • Where will you park?
  • Where will you put your bags?
  • How long does it take to get there?
  • What is the temperature of the room?

Ponder anything you can think of that will put your mind at ease.

Don’t forget to plan your exam break time as well. Be sure to pack healthy Step 1 exam day food. We recommend a complex carb to start your day and provide longer-lasting energy; bananas and oranges offer lots of electrolytes and are convenient to carry. A snack bar is always an easy option with a nice sugar boost to help you cross the finish line.

Lastly, know where the bathrooms are. You don’t want to be distracted by a potty break in the middle of the exam.


USMLE FocusMistake 7: Focusing on the short-term and avoiding life post-exam

It might seem like Step 1 is the last day of your future, but it’s not. Just because it’s difficult to see over this hurdle, doesn’t mean you shouldn’t start plans for a post-exam time.

It’s an easy way to keep yourself motivated: plan something fun to do after the exam. You’ll need a reward, and this can be a nice refresher from the monotony of studying. Start planning something fun with a group of friends to keep the finish line in focus.

  • Plan a vacation with friends.
  • Make reservations at a nice restaurant.
  • Throw a party for you and your classmates.

As soon as that exam is done, you’ll be glad you planned this far ahead!

Exam day is hard enough. You already have too many things to worry about. So don’t be your own worst enemy. Try to recognize and correct as many little mistakes like these as possible, so you’ll be calm and confident come exam day.

Keep your head held high and your mind clear, and you’re going to do just fine!

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