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Don't kid yourself: From the moment you started med school, you knew  the day would come when Step 1 went from being a hazy mountain off in the distance to a clear and present challenge staring you right in the face.

Have no fear, though: Careful planning and diligent use of a select few high-yield resources will help you whip this test.

You've heard us extoll the virtues of UWorld and First Aid. However, beyond a doubt, no Step 1 prep regimen is complete without the full use of the six Step 1 practice exams offered by the NBME. The Comprehensive Basic Science Self-Assessments, or CBSSAs, are pure gold when it comes to preparing for the real USMLE Step 1.

Why should I use the NBME practice exams? I mean, do I really need them?

There’s a huge difference between having a strong fund of knowledge (i.e. knowing lots of information) and actually crushing Step 1. To be sure, you must know your stuff cold to get a top score. But you must also manage your time well, interface seamlessly with the test’s built-in features (including the calculator, lab reference tables, text highlighting, and answer strike-out), focus like a mental laser beam for eight straight hours, and, yes, even read the test writer’s mind. You cannot learn these skills from a book!

Even UWorld—though it comes close to mimicking the real test—cannot replicate the experience of the actual USMLE Step 1 as well as the NBME practice exams. The NBMEs contain real questions from real Step 1 exams administered in previous years. UWorld doesn’t. The NBME practice exams will accurately estimate your three-digit Step 1 score (with a +/- 10 point margin of error). UWorld question blocks won’t. (Not to mention, the UWorld self assessment exams actually inflate your predicted USMLE score by 20 points!)

It’s a fact: Only the NBMEs provide a forum in which you can use the real test software to take a four-hour timed test containing real-deal, regularly updated USMLE Step 1 questions. The advance practice this gives you will likely even permit you to skip the computer "tutorial" at the beginning of the real exam, thus conserving a portion of your total test-day time. By virtue of these distinct advantages, the NBME practice exams are truly the best possible way to assess your overall readiness for a USMLE examination.

I’m convinced! How should I use the NBMEs?

In order to assure your preparedness for Step 1, test yourself early and regularly and trust your NBME diagnostic results. Here are my three big tips:

1. You should take your first NBME diagnostic before you begin studying for Step 1!
 
Not only will this give you an accurate baseline score from which to track your progress, the NBME also breaks down your performance by subject, allowing you to personalize your studying to strengthen your weak areas. 

Bear in mind: Most students will not improve their scores by more than 40 points during a dedicated 8-week study period!  If your initial diagnostic exam tells you that your score won’t likely be up to snuff by your planned exam date, push your test back early to avoid unnecessary rescheduling costs and headaches.

2. Save at least one NBME practice exam for the week before your test.
 
If your calculated score estimate is not a solid 10 points—or, even better, a standard deviation—above the Step 1 passing mark, achieving a passing score on test day is in doubt. Consider pushing back your test date to allow yourself additional time to really get your score to where it needs to be. Remember, even if it seems like a hassle, it’s much easier to reschedule your exam before you take it, rather than after!
 
3. In the course of your Step 1 preparation, you should use all six NBME practice exams!
 
For high-yield gold, these practice tests are dirt cheap. Why wouldn’t you use every single opportunity to track your studying progress and hone your test-taking skills for the big day? Start off by taking the oldest NBMEs first (Forms 7 and 11 are currently the oldest), and wait to take the newest ones when you're closer to your test date.

What is expanded feedback? Do I really need to spend the extra 10 bucks?

In a word, YES. By purchasing the extended feedback (which, by the way, you should do for every NBME practice exam you take), you can review all incorrectly answered questions. 

Yes, the NBME does not provide either the correct answer nor the explanation to the question in expanded feedback. HOWEVER, it is by putting in the hard work of diligently ferretting out the correct answers to these tricky questions and reexamining the testing strategy areas where you consistently shoot yourself in the foot, that you can both master the high-yield information and your approach to the exam overall, that will result in a higher score.

I cannot emphasize this enough: If you're serious about earning a top score on your USMLE, you cannot be lazy. There is no magic pill for a high score. You must grit your teeth and put in the necessary time, focus and effort.

Warning: Be very careful about any “answer keys” you find online. These can be posted by anyone, and, in my experience, they are frequently inaccurate. While accurate answer keys do exist (the tutors at Med School Tutors, for instance, have devoted countless hours to creating their own verified master key), these will generally not be freely and conveniently available online!

Did you know you can take a practice test in the real testing environment?

Another way to get a leg up for your actual test day is to take a three-hour practice exam at your Prometric testing center. While this practice test will not provide you with any additional question material that is not already available from the USMLE website, it will give you a truly in situ testing experience and an additional estimate of your USMLE Step 1 score. 

Even if this step seems like overkill, don’t underestimate the pressure of your test day! Taking a dry run at the Prometric center before the big day can work wonders in calming your nerves.

A Parting Shelf and Step 2 Thought

You’ve still got your Step 1 ahead of you, and that should be your primary focus during the upcoming weeks, no question. But let me clue you in to one more thing: Although we often think to use the NBMEs for Step 1 preparation, we still frequently neglect the valuable NBMEs available for USMLE Step 2 and shelf examinations. In my experience, most students don't even know that the NBME offers practice shelf exams! So, once the NBMEs have helped you cruise through Step 1, don’t forget to look them up when it comes time for your shelves and Step 2 CK! 

Also, you can access the NBME Comprehensive Basic Science Self-Assessments for USMLE Step 1 here.

24 hours could earn you 30 more points
David Chapel

David Chapel

David is currently in his fourth year at Columbia University’s College of Physicians and Surgeons. He paired natural brilliance and daily diligence to attain straight honors marks during his major clinical year, and continued his success with rock-solid scores on the USMLE Step 1 and Step 2 CK. David has shaped himself into an outstanding mentor for medical students at all levels of study through a combination of truly remarkable academic ability, diverse extracurricular talents and six years of experience in student-centered tutoring in the basic and applied sciences.
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