Break time is vital, so you should have a good idea of how you are going to use it. The NBME officially gives you 45 minutes of total break time throughout the test. You are allowed to take breaks in between question blocks. There is no limit to how long or short your breaks can be as long as the total break time remains under the 45-minute allocation. If you leave the testing room, you must check back in (which means waiting in line, showing your ID, scanning your finger)... This process can take anywhere from 30 seconds to 3-4 minutes depending on the number of people checking back into the room at one time. Important to be aware of this, since in reality your planned "5-minute break" will probably not equal 5 minutes of break time.
As soon as you click "Start Exam," your first 15 minutes are reserved for doing a the tutorial on USMLE Step 1 testing software. You can gain an extra 15 minutes by doing the online tutorial ahead of time and skipping through it during the test. However, be aware that a few additions may be present on this tutorial which you may not have seen on previous tutorials (e.g., new information regarding Media Questions). In general, flipping through the tutorial will accrue you extra minutes for your break time. The link for the online tutorial is here (http://www.usmle.org/practice-materials/). If you finish blocks of questions quicker than the allotted 60 minutes, this extra time is also added to your total break time. You need to balance this benefit of extra break time with the risk of going too fast. Remember, you will only have 60 minutes for each block of questions and this never changes. If you practice the skipping strategy, you should be doing okay with time. If you expect a total of 60 minutes of break time (15 extra minutes from the tutorial), you have plenty of time to use the restroom and relax in between blocks.
Everyone is different with respect to taking breaks. Some students like to do two blocks of questions at once, while other students like to take short breaks in between each block. Personally, I am a restless person and prefer to take a short, five-minute breather in between blocks, even if I feel I don’t need it. Further, you should plan to take a lunch of 20–30 minutes at some point midway through your test. You can also expect that your stamina will wear out as the day goes on, so you may want to position longer breaks toward the end of the day. You should have a tentative break plan in your mind when you walk into the test. See below for a sample plan:
Plan Your Snacks/Lunch
You should also plan to bring light, energy-producing snacks and beverages along with you to the test center. Pack some sort of light lunch that can remain unrefrigerated (or bring a cooler pack); don't plan on buying lunch because it is too unpredictable what may be available and how long it'll take. If you're going to need coffee, bring a thermos... again, buying may be a risk and take longer than predicted. And of course, keep your lunch very light (fruits, nuts, power bars, crackers, small sandwich... not a large burrito); you'll be going back for 3-4 more blocks after lunch and don't want to be in that heavy alkaline tide from your food coma.
Watch your fluid intake... using the restroom mid-block is a bad idea since the clock keeps on counting down regardless. Use the restroom during breaks between blocks, and even so, plan for a "10-minute break" to do so, given that you may run into hurdles coming in/out of the testing room. Isotonic fluids (gatorade) will have less of a diuretic effect than will hypotonic fluids (water). Either way, don't restrict your fluid intake completely, but watch what you drink. Again, if you're a coffee drinker beware of its diuretic side-effects... and if you are not a coffee drinker, now is not the time to start. The general rule is: Continue Doing Whatever Has Been Working For You!
Plan Your Travel and All Required Documents
Do yourself a favor and figure out where your test center is before the morning of the test. Anticipate how long it will take you to get there through traffic or public transportation. Read the instructions on the test center printout to make sure you bring all the necessary forms of identification and testing documents. You don’t want to deal with the stress of being late or forgetting something the morning of the test. Normally, they request that you get to the testing site 30 minutes before your set start time, but check your printout to confirm this. Recheck the night before the checklist of all required documents (ie, scheduling permit, ID, etc) and make sure everything is all ready to go the night before so you don't pack carelessly the morning of the exam.
Just Do It
Your time is now! You’ve done everything we’ve asked of you. You are now adequately prepared to tackle this exam. Do your best, and leave it all on the “field.” Your job is not finished until the seventh block is over. Do not give up before then, no matter how difficult you think the test is. If you see it through, you will be so glad that you did. Be proud of yourself and the effort you have put forth. You’ve done an amazing job up to this point; now it’s time to finish the job. See you on the other side! Don’t forget to write us and let us know how it went. Your feedback helps us make the program better every year.