Step 1 Strategy for USMLE

The Four Step Approach

Think of it this way....You have three chances to get each USMLE question right. If you cannot arrive at an answer using these three attempts, you do not know the answer. Mark your favorite letter and move on to the next question. The key to this strategy is that you always know what you are going to do next. This helps you feel in control and reduces anxiety.

1. Read the Question
This may seem trivial, but studies have shown that most students look at the answers first. Questions cause anxiety and answers provide the solution, so many people go right for the solutions. However, you cannot pick the correct answer until you know what you are being asked! Time reading the question is time well spent. More time on the question means more time spent thinking.

Read the question and pick out key words. Key words are diagnostic information, abnormal lab values, indications of gender or race and any qualifying terms.

Read carefully enough so that you only have to read the question once. Rereading takes time. Read for comprehension the first time.

2. The Prediction Pass
After reading the question, stop. Before looking at the options, try to generate an answer. We call this the PREDICTION PASS. USMLE questions are written so that any expert in the field can come up with the correct answer without having any options present. While you may not be an expert in every field, you should still try to predict the answer before venturing into "answer choice land."

With the correct answer in mind, you are less likely to be seduced by distracters. Remember, they are supposed to distract you and convince you to pick the wrong answer. Distracters aren't just randomly generated; they are answers that sound like they could be right.

3. The Selection Pass
If you see the answer you predicted, scan the other answers to be sure that it is the best. Then, pick it and move on to the next question. This is the SELECTION PASS. If the answer seems obvious and direct, good. Do not convince yourself into thinking the question must be tricky or more difficult. Most answers will be clearly correct. If you find yourself making up a long story why one option is better than another, stop yourself. You are probably wrong. The correct answer should be clearly correct. If two answers seem to be almost the same, then neither one is probably correct.

4. The Final Pass
If, after reading through the options, you are still not sure of the answer, you have one final try, the FINAL PASS. At this stage, rather than trying for a correct answer, you are eliminating those you know to be incorrect. Using this strategy, you can usually eliminate all but two of the options.

When you have narrowed your choices down to only two options, you have now arrived at the most crucial moment. The correct action at this point is to pick one and move on to the next question. If you are really unsure of the correct answer, which one you pick does not matter. With two options to choose from you have a 50% chance of getting the question correct rather than the 20% chance you started with.

Make a choice. Many people waste time at this point by not choosing. Some people, when they have eliminated all but two answers, go back and reread the question in hopes of finding some information that will help them choose. Time spent talking with students and watching their thought processes during the exam suggests that this is the wrong strategy.

When students reread a question at this point, they tend to add to it or pick out single features that help them feel better about choosing one of the answers. However, it does not help them pick the right answer. By adding assumptions to the question, students may feel more confident, but they are really mentally rewriting the question to be one that they feel more comfortable answering. The answer they pick is then the right answer to the question that they envision, but not for the actual question presented.

If after these three passes: Prediction Pass, Selection Pass, and the Final Pass, you still are not sure of the answer, your best option is to guess. At this point, click any letter and move on to the next question. Remember, the key to doing well on this exam is to train yourself to make choices. If you do not know an answer, admit it, make your best guess and move on to the next question.

NO ANSWER COUNTS THE SAME AS A WRONG ANSWER.

Try out this four-step method as you do practice questions in the weeks before the exam. If it helps you feel in control of the questions, that's great. If you find it doesn't work for your test-taking style, it might be too late to adopt it now. Remember, you need to do what works for YOU.

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Kaplan is a registered trademark of Kaplan, Inc. USMLE is a joint program of The Federation of State Medical Boards of the United States, Inc. and the National Board of American Medical Examiners.