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A common question many of my students ask is: “How do I combine taking practice NBME exams with working through UWorld?” Since there are a limited number of NBMEs available, it’s not a good idea to start before you’ve absorbed enough knowledge from UWorld. However, if you start too late you may miss out on the potential benefit of watching for trends and improvements over time.  

Here are the top strategies for how and why to use NBMEs alongside UWorld:

1. NBME practice exams help you gauge your progress during your studies.

This is particularly helpful for students who like to get an estimated benchmark of their current performance. NBMEs are great for illustrating progress as you complete UWorld.

2. If you’re eager to see your progress as you study, take an NBME practice exam early in the USMLE study period.

Some schools mandate that their students take a basic science NBME type of exam before their designated study period. However, in many cases students take this exam with very little, if any designated Step preparation outside of their regular courses. Therefore, regardless of whether or not a student has taken a school administered NBME exam, I usually recommend that they take another NBME early in their study period. I’ve found that for many students, it’s usually best to take the first NBME after completing about 1/3 of the first pass through UWorld. That way they have some studying under their belt, but still have a measure of where they stand early on.

3. Depending on the length of a Step study period, I might recommend an NBME about every 2 weeks or so.

In most cases, I advise taking another NBME assessment about 50% of the way through UWorld, and then another near the end of or just after finishing UWorld.

This tends to give a better idea of performance over time. Generally, most students start to receive higher NBME scores once they complete at least half of UWorld and as they get closer to finishing the entire Qbank.

4. NBME scores tend to be more predictive of what might happen on test day once one is or finished or nearly finished with all of UWorld.

UWorld is well known as one of the best resources to prepare for the Step exams because it provides such a breadth and variety of practice questions. The key to doing well on NBME exams and on the real test is to get through as many practice questions as possible.

5. Ideally, take the last NBME no closer than 10-14 days from one’s desired USMLE test date.

Students always place the most pressure on themselves when taking the last NBME before the real exam. Therefore, it is not uncommon that this score could be a little lower than desired due to added pressure, nerves, etc. For this reason, it is important to leave a cushion of at least 10-14 days before this final NBME and one’s real exam so that if a lower than desired score is obtained on this NBME there is time for the student to focus on what went wrong, readjust study strategy, target weaker areas, etc. If one takes an NBME three or four days before the scheduled exam and doesn’t perform as well as desired, this doesn’t leave much time to troubleshoot. Additionally, a lower than desired NBME score a few days before ones scheduled NBME test date can really hamper on one’s confidence going into the exam.

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Justine Falcone

Justine Falcone

Justine graduated Summa Cum Laude and co-valedictorian from Rollins College before pursuing an MD from the University of Florida. She is currently a PGY-2 in Emergency Medicine. Justine scored 245 on the USMLE Step 1 and 255 on the Step 2 examinations. She scored 80 or above on five of her NBME shelf exams during her clerkship years.
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