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Let’s not mince words: NBME practice tests are an essential part of your USMLE Step 1 preparation. Nothing will provide the same simulative or predictive value of an NBME self-assessment. Not USMLE World, not Kaplan Q-Bank, not USMLE Rx —nothing. These other resources can all serve a purpose (especially USMLE World), but only NBME tests will give you assurance that you are ready to pass Step 1 and achieve your goal score.

So, this brings us to our real question. What are the best practices for using and interpreting NBME self-assessment exams?

To start, let’s review some of the facts about NBME practice tests:
  • There are 6 NBME self-assessment exams for USMLE Step 1
  • They can be taken in timed or self-paced mode
  • They consist of 4 sections (about half of the real exam)
  • “Expanded feedback” offers the opportunity to review questions you get wrong, but without an answer key or explanations
  • NBME tests are highly predictive of your real USMLE performance (more below)
Perhaps you knew all or most of those facts before reading this blog, so let’s dive into some dos and don'ts for using NBME self-assessments:

The Dos

Take an NBME self-assessment early! The first thing we tell students, even before we match them with a tutor, is to take a ‘diagnostic’ NBME. A diagnostic NBME test allows you to pinpoint your areas of weakness and your baseline score, so that you can create the most effective and realistic study plan. This will also give you exposure to test-like conditions and questions right away, which can help put material in context as you study.

Choose the “standard-paced” (timed) setting. Since NBME practice tests function best as assessments of your progress and readiness for the real USMLE Step 1 exam, you absolutely must take them under test-like conditions. This means with proper timing and break time. Without this setting, the predictive value of the exams will not be the same.

Purchase the ‘expanded feedback’ option for every NBME test. Even though NBME tests function best as predictive assessments, they are still composed of real USMLE questions that have been retired from previous tests. Thus, they are an incredible source of additional questions and information to add to your arsenal for test day. Students regularly report seeing some of these questions word-for-word on their test day! Be certain to target your weakest subjects (bars to the left on the score report) in your review before you take your next practice test.

The Don’ts

Do not rely on publically available answer keys unless you know and trust the author. Many students attempt to review their NBME tests using shoddy answer keys available online. We have examined many of these ‘answer keys’ only to find that most contain countless inaccuracies. Consult your First Aid or a professional to get the right answers. It will take time, but it is worth it.

Do not wait to take all NBME self-assessments at the end of your study period. Doing so will not only burn you out as your exam approaches, but it will also limit your ability to learn and improve between tests. Ideally, NBME self assessments should be done roughly once per week throughout a 5-8 week study period. We know that it can be nerve-wracking to take a simulated exam, but confronting your fears and weaknesses early and often will help you score higher on your USMLE exam.

Do not ignore what the scores are telling you. NBME practice tests are the most precise predictors of your USMLE Step 1 score. It does not matter which NBME form you are taking, they have all been scaled by the NBME to reflect your likely performance on the real USMLE. Our experience with hundreds of test-takers shows us that NBME tests tend to predict your real score within approximately +/- 10 points. To be sure you are ready to pass or achieve a certain goal, it is most responsible to be 10 points above that target before test day. If you are not yet there, consider postponing your test or seek guidance about the best move for you.

Of course, there are other factors and observations to consider when integrating NBME practice tests into your USMLE Step 1 studying. We’d love to hear any other questions/comments you have on this topic and also learn your experiences using NBME self-assessment exams. The more we all know about using these crucial tests, the better all test-takers will be prepared for their Step 1 exams.

For more information about NBME correlation with the real USMLE exam, visit these links:

Relationship between performance on the NBME Comprehensive Basic Sciences Self-Assessment and USMLE Step 1 for U.S. and Canadian medical school students

Using the NBME self-assessments to project performance on USMLE Step 1 and Step 2: impact of test administration conditions

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