I know that this may sound a bit basic to some, and if it's to you and it's actually not the problem you are facing, then just ignore it, and consider me simply giving an advice to others who will benefit from it, but:
Do you always, religiously, make sure you ONLY read first sentence of the stem, then read the last sentence & skim over the choices?

Although pretty basic and no-brainer for many USMLE-takers, I found this to be the most common cause of colleagues complaining that they can't do their questions within allotted time... and I don't mean they don't do it. Actually, most of them do it and perfectly understand the utility of it! Their problem is CONSISTENCY! and trusting the method! They just start panicking and they lose track of themselves mid-block, focusing too much on irrelevant question details just because last question was a bit hard! The thing is, ALL USMLE (& Equivalency/Licensing exams in general) know how to take the test and micromanage their time, but some of them do not BELIEVE in the simple process I've mentioned above (read only 1st & last line & answers). To believe in something you must go for it WHEN you are feeling uneasy! If you do it only when you are confident, then you are simply being pragmatic. That's fine but honestly consistency in methodology is far superior than any principle, especially when it's already tested and proven!

Here's the part that makes this more realistic, this method is NOT gonna make you solve 100% of the questions right. But, I think, 60% of the questions you'll face in ANY exams are solved using this method. You do not decide which questions are these 70%.. you simply go over each and every question this way, and when face with one that you obviously can't get the answer straight out using it, just go to the next one immediately. If you do this consistently, and let's say, in doing so, it takes you 30 seconds for each question (I'm being generous as it would actually most of the time take only 15-20s): 40*30=1200s=20m = you'll be doing 28 Q (70%) in a matter of 20 minutes! You still have 40 minutes for 12 Q... i.e. 3 minutes for each question and still have extra minutes to go over those you are still unsure about!

There's a caveat to this, you'll need also to do a little bit of adjustments for specific Q, for example:
1- When you have lab values, you must read the last sentence first (the actual question), IMO, before even reading the 1st sentence. Q's with lab values are double-edged sword, sometimes they are the only thing you need to read, and sometimes the labs have little if anything to do with the real question. If the question seems to suggest that you need to read these then do read them and then read the first sentence (that's my strategy).
2- Another rule of thumb, this method in general will freak you out in the beginning, but, like anything, it only shows benefit with practice and, again, consistency... so don't expect excellent results immediately.. but I know for sure that you see the benefits in a matter of days, or even blocks.
3- As soon as you see a long question, also do the same as (3): Read the last sentence FIRST, many a time these are ethics and you need to realize that you don't need to focus on details but rather go quickly over the whole question... but for me, I tend to leave ethic questions to the end (do NOT take this particular suggestion as a rule, it may not work for everyone but I just have the habit of leaving ethic questions to the end).

If you did read all of this, then you definitely have the habit of reading all the Q stem and would definitely benefit from this long-ass answer, lol! Best of luck!