Knowing the material is necessary but not sufficient for performing well on exams. How you approach questions, manage your time during the test, and handle uncertainty all affect your score independently of how well you prepared. Test-taking strategies bridge the gap between what you know and what you demonstrate on exam day. This page covers evidence-based approaches to multiple-choice exams (the format used by the MCAT®, DAT®, USMLE®, NCLEX®, PANCE®, and most pre-health course exams), time management during tests, handling difficult questions, and managing test anxiety.
Reading the Question Before the Answer Choices
On standardized exams, the question stem often contains a clinical vignette providing essential context. Read the entire stem carefully before looking at answer choices. Many errors come from misreading the question, missing a key word (“most likely,” “least likely,” “next best step,” “initial”), or answering a question the stem did not ask. After reading the stem, formulate an answer in your mind before looking at options to prevent anchoring toward a plausible but incorrect choice.
For long clinical vignettes (common on the MCAT®, USMLE®, and similar exams), some students read the actual question (last sentence) first, then read the vignette with that question in mind. This helps focus on relevant details. Try both approaches during practice exams and use whichever produces better results.
Process of Elimination
When unsure of the correct answer, systematically eliminate choices you know are wrong. If you can confidently eliminate two wrong answers from four options, you have a 50-50 chance on the remaining two, significantly better than random guessing. Look for choices with absolute language (“always,” “never,” “all,” “none”), which are often incorrect because most situations involve exceptions. Look for choices out of scope or contradicting information in the stem.
Time Management During the Exam
Before the exam, calculate your time per question (for example, 95 minutes for 59 questions on an MCAT® section gives roughly 1 minute 36 seconds per question). Monitor your pace every 10 to 15 questions. Do not spend more than 2 minutes on any single question during your first pass. If you are stuck, make your best guess, flag it, and move on. Spending 5 minutes on one question means spending less time on three questions that might have been easier.
Should You Change Your Answer
Research consistently shows that when students change answers on multiple-choice exams, they are more likely to change from wrong to right than from right to wrong. However, this benefit applies only when you change based on a genuine realization (recalling information or recognizing a misread). Changing because of anxiety without new information is less helpful. If you have a clear reason to change your answer, do so. If you are changing because another option “looks better” without specific rationale, your first instinct is probably correct. Track your answer changes during practice exams to understand your personal pattern.
Handling Questions You Do Not Know
Every exam includes questions testing material you have not reviewed. This is expected and not a sign of poor preparation. Eliminate choices you can based on general principles, make a strategic guess from the remaining options, and move on. On exams with no penalty for wrong answers (MCAT®, DAT®, USMLE®, and most others), never leave a question blank. A guess gives you a chance; a blank guarantees zero points.
Managing Test Anxiety
Some anxiety before an exam is normal and can improve performance by increasing alertness. Excessive anxiety impairs working memory and recall. To manage it: simulate test conditions during practice so the format feels familiar on test day; reframe anxiety as activation (“I am ready” rather than “I need to relax”); focus on the process (answering each question carefully) rather than the outcome; and seek professional support if test anxiety is persistent and severe.
Seek Support If Needed: If test anxiety is a persistent and severe problem, speak with your school’s counseling center or a mental health professional. Effective treatments exist, including cognitive-behavioral techniques specifically designed for test anxiety. Seeking help is a practical strategy for removing a barrier to performance.
For related strategies, see our guides on active learning, spaced repetition, time management, and reading scientific literature.
Pattern Recognition on Standardized Exams: After completing hundreds of practice questions, you will begin to notice recurring patterns in how questions are constructed and what concepts they test. Certain diseases, drug interactions, and clinical scenarios appear frequently because they represent high-yield clinical knowledge. Keep a running list of these “frequently tested concepts” during your practice and review them periodically. This is not about predicting specific questions but about recognizing the types of clinical reasoning the exam rewards.
The Art of the Educated Guess: When you must guess, do so strategically. In clinical vignette questions, the correct answer is usually the most clinically appropriate action for the scenario described. Extreme or aggressive interventions are often wrong unless the question specifically describes an emergency. “Do nothing and observe” is sometimes the best answer, particularly in pediatrics and obstetrics questions where watchful waiting is appropriate. Answers that include patient education, informed consent, or shared decision-making are frequently correct in ethics and communication questions.
Post-Exam Reflection: After each practice exam or course exam, review your performance systematically. Do not just check your score. Categorize your errors: did you miss questions because you did not know the content, because you misread the question, because you changed a correct answer, or because you ran out of time? Each error type requires a different correction strategy. Content gaps require more study. Misreading errors require slower, more deliberate question reading. Time pressure errors require pacing practice. This analysis makes every exam a learning tool.
Physically Preparing for Test Day: Your physical state significantly affects your cognitive performance. In the days leading up to the exam, prioritize sleep (at least 7 to 8 hours per night), regular meals, and light physical activity. Avoid introducing new foods, supplements, or caffeine habits on exam day. Eat a balanced breakfast that includes protein and complex carbohydrates, and bring familiar snacks for breaks. Dress in layers so you can adjust to the testing center temperature. Arrive early enough to go through check-in without feeling rushed.
During Breaks: Use scheduled breaks strategically. Stand up, stretch, walk briefly, and use the restroom even if you do not feel you need to. Eat a small, familiar snack and drink water. Do not review study notes during breaks; your knowledge base will not change in 10 minutes, but anxiety might. Use the break to reset your focus and energy so you can approach the next section with a clear mind.
After a Difficult Section: If you finish a section feeling like it went poorly, do not let that feeling affect your performance on subsequent sections. Many students experience a “doom spiral” where a perceived bad section leads to distraction and underperformance on later sections that they were actually well-prepared for. Each section is scored independently. Put the previous section behind you mentally and bring full focus to the next one.
References
Benjamin, L.T., et al. “Staying with initial answers on objective tests.” Teaching of Psychology, 11(3), 133-141, 1984.
Brooks, A.W. “Get Excited: Reappraising Pre-Performance Anxiety as Excitement.” Journal of Experimental Psychology: General, 143(3), 1144-1158, 2014. https://doi.org/10.1037/a0035325. Accessed March 2026.
Dunlosky, J., et al. “Improving Students’ Learning With Effective Learning Techniques.” Psychological Science in the Public Interest, 14(1), 4-58, 2013. https://doi.org/10.1177/1529100612453266. Accessed March 2026.