At the start of the day, the exam may seem to be a mountain. Trying to climb that mountain can seem difficult, if not impossible for some. The secret to conquering the mountain is to take it step by step, one step at a time. In the same manner, the secret to conquering the USMLE is to take it question by question, one question at a time.
At its most concrete, an exam is nothing more than the sum of a set of questions. Each question poses its own special challenge and possibilities. And each question is independent; this means that what you did on the previous questions tells us little about your chances of getting or not getting the next question correct. If you get one question wrong, that does not hurt your chances on the next one. If you get one right, that does not boost your chances on the next question either.
When faced with the USMLE, most students want to know how they are doing. They try to keep running tallies in their heads. The problem is, you can't really tell how you are doing as you move through the exam. You will get questions correct that you are sure you got wrong, and will get questions wrong that you are sure you got right.
Worse, this subjective sense of how you are doing disturbs your exam performance as you move from question to question. It you think you are getting questions wrong, you become discouraged. If you think you are doing well, you may get complacent and sloppy in your thinking. In short, evaluating yourself in the middle of the exam is, at best, a waste of time; at worst, it is a tactic guaranteed to hurt your score.
To avoid this pitfall, train yourself to focus on the question before you, not the exam as a whole. Your cognitive task in each minute of the day is not to "handle the exam," but to focus on, think about, and answer the question before you on the screen. Each question offers a new opportunity, a fresh chance for you to show what you know.
Dealing with the exam in this manner is the result of a mental discipline that comes only with practice. When you answer your practice questions, focus more on how you read and handle each question than on whether you get the question right. If you adopt this attitude, you will not only be less emotionally distracted, but will find your actual performance improving as well.
Taken as a whole, the exam may seem overwhelming. The day stretches on until fatigue obscures the end. The progression of questions seems endless. Time seems to speed up as a sense of urgency propels you to race ahead. When you get this feeling, stop, take a deep breath, and focus on nothing but the question before you. Handling each question one at a time in a steady rhythm will get you to the top of your mountain