Specifically for STEP 1, I wouldn’t study differently at all.
But I’m not really going to beat myself up over this because I think test fatigue affects almost everyone and almost everyone makes a few dumb errors they wouldn’t normally make due to it. By the last three blocks, I started to be less thorough with my reading of questions. However, the pressure and multistep questions on the real deal really do wear you down. I practiced taking 8 blocks a day on more than a few occasions. I definitely made some really dumb mistakes here and there, especially in the later blocks. I still managed to finished, but it wasn’t a good feeling to see those red digits wind down as I frantically clicked the bubble for my last answer. The people at my test center were super slow at signing people in after breaks.
However, I needed almost all the time just to get through the tougher blocks. On the actual exam, the easy blocks took me about 40-50 minutes and left me a good amount of time for double checking. I’m generally a good standardized test taker and fast reader, so, when practicing, timing was never an issue. The pathophysiology was on the same level. It was a lot of “can you figure out the most reasonable explanation/mechanism for this common medical phenomena.” The physiology was easier than both Kaplan and U World. The most difficult questions had to do with pathogenesis. It felt like recall questions with weird organisms or drugs as the correct answer were all purposely designed so that someone who knew all the high yield information could effectively eliminate all of the other choices. Some blocks were about the difficulty level of U World. Some blocks were easy and felt like NBME 18 and 19. USMLE RX 70% completion (along with First Aid and DIT to hammer first aid) Kaplan 70% completion (mostly done through med school) DIT (About 70% and coupled it with first aid, since I lack the discipline to sit there and read)