TOEFL is more than an English exam

I have to take TOEFL which is a test often used for measuring English skill of non-native English speakers applying for universities in the US. Even though I am not going to a school, I need it to become a pharmacist here. It is very important for pharmacists to have good communication with patients and doctors so they need to use English fluently. I agree with that. However, TOEFL is very tricky. I heard that even average native speakers can get score 80 out of 120. Many international students are required to get around 80 for entering their universities and over 90 for some good graduate schools.  I am required score much more than that.

In the test, you have to listen to university levels of lectures for 5-10 minutes each and then answer questions about the lectures or write those summaries and your opinions. Please think about it. Do you remember all the details if you are not familiar with or not interested in the topic? Can you write a good essay within 20 minute?  Can you make a good one-minutes-speech just right after you asked to state your experiences or opinions about something? I cannot do that even in Japanese.

This is more than just an English exam. I have to prepare for it seriously.