Today, we will talk more about the NBME self-assessment tests. We previously discussed what the NBME self-assessment tests are and how they impact your USMLE review. You can read the posts here. Now we will cover three important topics. When to use the NBME self-assessment tests, how to use the NBME self-assessment tests and how wise it is to use the USMLE World self-assessment tests instead.
We now know that the NBME self-assessment tests are accurate in predicting actual USMLE performance. And we also know that the main reason for this accuracy is the correlation study done by NBME between the two tests using AMGs performance in both tests rather than to any real similarity between the 2 tests. This correlation has also been borne out by most test takers who narrated their experience in forums. It can be used to gauge whether you will pass the examination and even if you have a good chance of achieving the score you are aiming for.
So when is the best time to take the NBME? The best time is when you think that you are ready for the USMLE. When all parameters indicate that you are probably ready for the examination, you take the NBME to confirm that you are ready for the examination. In other words, use the NBME as a diagnostic or confirmatory test, instead of a screening test. You can use your performance in USMLE World or Kaplan Q Bank as a screening test.
The practice of many to take the NBME to identify weak points and measure progress in review is not very practical. First, there are only 6 NBME tests (for Step 1) and second, you can take it only once. Taking it more than once invalidates the correlation and therefore its accuracy in predicting actual USMLE performance. Therefore, what do you do if you are still not ready after taking all six tests? You just used up your most valuable tool for predicting your actual performance in the USMLE.
Personally, I used the NBME exam to confirm my readiness to achieve my targeted score of 99. In preparing for Step 1, when my Kaplan scores were hitting 84 and above, I felt I was ready for the test. I took NBME form 1 only and 740 confirmed my readiness for the exam since I was aiming for a 99. 600 was enough for a 99, but I would have postponed if I got less than 660. Why? Since I decided I want only a 99, I was giving myself a 10 point leeway (600=240 and 660=250) to make sure I make it to a 99 no ifs, ands, or buts. 
The same thing holds true for Step 2 CK, I took the exam when my one and only NBME test scored 700, way above what I needed for a 99.
Another common question is whether to take the examination timed or self-paced. Since you are trying to test your actual readiness for the examination, it is best to simulate actual exam conditions. In my case, I took self-paced but finished everything in the 1 hour allotted for it. I may look over the questions after 1 hour, but I will not change them so as not to alter the score predictability too much. Make sure everyone in the house knows not to disturb you while doing this. Although you can pause the exam, it is not recommended. Also I do not recommend you do it in a public library. There was one person who took the USMLE despite getting a low score in NBME. He attributed it to the fact that he took it in a noisy public library and “upward adjusted” his predicted score. He failed. So, take it properly and trust the score. One warning, though, correlation is not 100% therefore always give yourself some leeway in case things do not go too well. Never, ever go for the examination if you scored 400 or less. Your chances of failing is too high and even if you passed 75 and 76 are with you for life.
Recently, USMLE World started offering their own assessment tests for US$ 30 each, US$ 15 cheaper than NBME’s assessment tests. The question foremost in everyone’s mind is, can I switch to UW assessments tests instead of NBME’s. How wise is a decision like that?
The reason for using assessment tests is to make sure you are ready for the USMLE and to lessen the risk of getting an adverse score. NBME has proven throughout the years, after thousands of test takers, that it is a reliable predictor of your actual score in the USMLE. It is also backed up by correlation studies that have been published in journals. Now, although USMLE World’s assessment test may also be a reliable predictor of your actual USMLE performance, all we have is their word for it. No study has been cited or provided to independently verify such claim. And not enough empirical evidence from test taker’s experience forums allow us to make any judgment on its accuracy at all. Surveying forum after forum reveals variable experience with the tests as of now.
My take is that since you only have one shot at the USMLE, it is better to go with what is proven and tested rather than take a risk. Although, you can retake the USMLE if you fail, that failure is recorded and counted against you. If you pass, the score is with you the rest of your professional life. If you chose to, maybe you can use the UW assessment tests as a screening tool. Just be sure to use the NBME assessment test, whatever form to confirm your readiness before actually sitting for the USMLE.
Hi doc,
I failed step 1 in May 09 with a score of 172/69. I have now studied from July to now (8 months). I got 330 in NBME 5, and 350 in NBME 6. I am so confused as to why my score are not higher as I usually am able to answer questions correctly while discussing with people who eventually end up scoring in the 90s. I am so tired and my exam is in a few days. Any advise for me?
Hi Vimo,
First, my advise is not to take the exam. You have a very good chance of failing it. Even if you are lucky enough to pass it, your score will be so low that your chance of getting interviews will be virtually nonexistent, especially with a previous failure. Postponing your exam for 3 months may not work either because from the look of things you are burnt out and have plateaued already. Which means that studying further will not increase your score by much. That is part of the reason why I tell people to finish your prep within 6 months as most people plateau between 6 to 8 months. When people have plateaued, the only solution is to stop studying for 2 weeks to 1 month altogether. (for some it can take 2 months to recuperate) then restart your prep. Usually you need less time for prepping this time around as you still remember a big chunk of what you have reviewed previously. All this is discussed in my prep course lectures and are some of the most common mistakes made by people prepping for Step 1.
As to why your score is low, I could think of a dozen reasons why you are having these problems but writing all that down will take pages. In fact those reasons occupy most of my live lectures in the course. But the single biggest reason is lack of mastery of the topics tested. Make no mistake, you know most of the topic tested in the USMLE, but you have not mastered those topics in the level required by the USMLE.
Is there a difference between knowing a concept and mastering it? Yes a lot. If you know a concept, given enough time and clues in the question, you can come up with the answer for the question. But given this is the USMLE, you do not have enough time nor enough clues. The higher your mastery of a subject, the faster you can recall them and the less clue you need to realize what the question is asking for and coming up with the answer. When you discuss questions with your friends, you take more than a minute to tackle the question and that means more time than the minute you are given in the actual exam. Second, unless you confined your discussion to the exact wording of the questions, you gain extra clues to what the question is all about during the discussion, hence you are able to get the answer. In the actual exam, you don’t get these extra time or extra clues.
That is part of the reason why I frown on this question discussion exercises in forums and do not bother to include it in my prep course. They just give you a false sense of security that your are improving when you are not.
There are a lot more reasons why you are having this problems including not assessing your progress regularly or properly, prepping for too long, prepping the wrong way, etc. All these are addressed in my prep course from the beginning so people do not waste so much of their time prepping the wrong way with adverse results.
After reviewing for so long, people always find it hard to accept that they have no choice but to restart their prep, correctly this time. In fact, some of them decides to proceed with the exam and failed it, which of course just makes it that much harder for them to match later on. Again, my advise is not to take this exam. Take a break for 2 weeks to 1 month. Restart your review, doing it the right way this time.
Askdoc
Hi Askdoc,
Thanks for your feedback. I sent you a PM and would be grateful to get your response as soon as possible given the next steps I decided on. Thanks again.
vimo
Hi..Doc. I have been Stdying for Step 1 now more than 6 months.. i revised Kaplan TExt Books four times.. and REviewd First Aid twice.. so i thought i should assess myself soon before the REal Thing..as i took the upcoming month for my Exam.. so i decided to take NBME..took form 2 i gave it last night with full enthusiasm and confidence.. but its unfortunatley its awkward and sad to tell u that.. i scored 200. and thats more than worse for me. it destoyed my whole courage and i feel insulted. As i have much actual knowledge than i was being test on. but anyways.. Plz Doc. Help me on this.. what should i do..i wanted to take the reall exam within 15 days..but i m confused now. is there something i could add up to my study strategy or m i missing something. or what..! I am impressed by ur scores 99..i wana know what i am lacking here..
please do reply soon..as i am counting my days..
Adnan
Hi Adnan,
sorry to be the bringer of bad news. But 200 is as bad as it can get. You need a 400 to have a good chance of passing this exam. Since you have used the right materials to study (except for qbanks, you need to do qbanks too) the main problem maybe is that you do not know how to study for the USMLE. If you look at the forums, people study the same materials all the time, some get 99′s, others fail. So problem lies elsewhere. There is no way you can take the exam in 15 days. In fact with your score, there is no way you can take the exam in the next couple of months. If you were to make a chart, after 6 months of study how much progress have you made. If you started at 0 (highly doubtful, since when I started my prep I was around 200 and this was because I was an old grad 16 years out of medical school and ended at 740 when I finished.) It took you 6 months to reach 200 and to reach 400 you may need about the same time. However, I believed you started somewhere at 200 to and that means you have done 0 progress in 6 months.
That is something that cannot be fixed by just a few words of advise. That is the main reason I created my prep course. Most people will be able to pass this exam with just some advise, but there is always a subset of people that can only pass this exam with thorough coaching and that is what my prep course is about. But it is your choice. It seems you need a lot of help to pass this exam and not just advise. I wouldn’t advise the Kaplan prep course as what they’ll probably do is just give you a bunch of books to read and lectures to listen to without teaching you how to study. USMLE PASS in Chicago offers some one on one coaching but they are very expensive. I think it’s about US$ 3K for 2 weeks and most stay for 6 weeks or pay around US$ 9K. The cheapest alternative will be to find a friend who knows how to teach you how to study and willing to sit down with you for 6 months.
If you want to understand why you need to know How to Study, listen to my video on How to Master the USMLE Step 1 – an Introduction. As I said most people can pass this exam without enrolling in courses. But you my friend may not be one of them. So you have a big decision to make.
Askdoc
HI. DoC ! i guess ur rite.. from day 1 my strategy wasnt great at all.. but 3 months back i wanted to go thru all those text books at least 2wice for my Basic Concepts which i did pretty well but the problem i lack was.. how to modify my knowledge and practice the most important tested material.. so its past now i can not take that tiring journey back into those Kaplan books.. so here is a thing.. as i have decided to delay my test but i dont want it to be 6 months..i think 3 more months or so..if thats ok in ur opionion.. secondly, tell me someone told me to go thru USMLE WORLD materials.. they are helpful? also tell me, is it fine if i just practice MCQs thoroughly and USe First Aid Review Instead.. coz its a big pressure on me and also a time factor.. i mean my basic Concepts are well but i wasnt really familiar with what kinda
MCQs would surprise me…
My last Question is that… which Assessment FORM ..either UWORLD or NBME is a straight away actuall corelation with this EXAM,, coz i have been told that nowadays USMLE WORLD is the real thing and that they are what you will see 80% in the real exam and NBME just distorts ur emotions and might bring down ur confidence one way or the other way.. i mean totally confused.. also tell me where can i find ur Prep Stuff and ur strategies…
THANKS
ADNAN
Hi Adnan,
My problem is I am not sure what you plan to do will be enough. You can try, but I still fell you need to do Mastery phase rather than go from learning phase to Test preparation phase and do well.
Next, the reason NBME is a good predictor of USMLE performance has nothing to do with how well it mimics the actual USMLE exam. It has everything to do with the correlation done between the performance of thousands of examinees who have done NBME vs. the actual USMLE result. In fact, NBME does not really reflect the questions that will appear in the actual USMLE. lastly anyone who tells you that UW is the real thing is either pulling your leg or does not know what he is talking about. both UW and Kaplan has more tough questions than in the actual USMLE, although UW has more tough questions than Kaplan. So either one is good enough for the USMLE. In the actual USMLE you get about 20-60-20 ratio of easy-medium-tough questions. In UW you get about 20-40-40 easy-medium-tough questions.
Lastly, I have written a lot about how to prep and exam strategies throughout my blogs and in some of the forums. But as I said, the most complete and well-organized discussions with numerous examples are of course in my prep course.
Askdoc
Hi. I have an issue. I took NBME 1 and received a 440, than took nbme 2 received a 560, took USMLE world and received a 530, and finally took nbme 3 and received a 490.. So what am I suppose to think? Should I stop studying?
Hi,
so after ur last advise, I got depressed cos i thought i have plateaued but i decided to pushed the exam forward from march 22nd to April 6th.
My improvements are Finished usmleworld with 72% average random timed unused with my last 10 being 80s and 70s, NBME 1 = 660/250, USMLEWORLDASSESSMENT = 650/248
NBME 6 (yesterday) = 620/244, Free 150 (yesterday) = 83,85,94, average = 87 , medfriend predicted 254.
I am planning to redo all the USMLE world questions i missed, do NBME 7, I am 5 days into doing DIT second time- plan to finish the remaining 10 days,
and I plan to read FA for five days b4 the exam.
what do you think. l felt like i dont see anymore new concept in every questions i do, just silly mistakes.
Hi JJ,
NBME correlation is not exact, there will always be variation. In order to actually understand what happened you need to at least give me when you took the exams. then what you did in between.
Askdoc
Hi articulate,
that is great. Your improvement is enough for you to get your dream score. Good Luck and keep me posted. I call your last statement “in the zone” that was how I felt when I did my exam. Of course, anxiety was still there but that is healthy as it keeps you on your toes.
Askdoc
Hi askdoc,
Thank you for your advice and sorry I got back to you so late. As I wrote in my previous posts, I was going to take my step 1 exam in Jan. but because my NBME score was 600/244 so decided to got though Kaplan q bank and my overall performance on that was 80%. Meanwhile I had some problem and was hospitalized so I had to postpone my exam. Finally I took step 1 on March 5th and today I got my score and it is 99/267. Much better than my NBME score and thanks to you for your advice.
Now I have to prepare for step 2. But the only thing that I know I can study is Kaplan lecture notes. Can you please help me?
As I told you before I am PhD student and have only 3-4 hours a day to study and I really want to pass the step 2 CK and CS before Sept. to apply for residency this year. Do you think I have a chance to finish before Sept.?
Again thank you for your time.
Nooni
Hi Nooni,
That’s great! Congratulations for a fantastic score. You are just in time. I am finishing an article called Most Common Mistakes in Step 2 CK prep. Hope to have it up in a day or two. Plus I have an article written for Step 2 CK years ago and was published in prep4usmle. I will repost it here in a day or two. it needs a rewrite but that will take time. So will just post it as is with some caveat.
Yes, there is enough time for Step 2 CK, You can take the exam on August. You can apply in September with Step 2 CK results pending and still have a good chance for interview with your step 1 scores. Just release it ASAP once the results come out.
Again congratulations for a really great score.
Askdoc
Well AskDoc, I took them about a week a part and since my last post I took a few more.. NBME 5 I got a 244 and USMLE world number 2, i got a 247. However I just took NBME 6 and got a 223.. I dont understand what the heck is going on. I had an avg of 67% on USMLE world Q bank.. I know there variations but a drop in 20 pts from one week to the next is ridiculous..
Hi JJ,
Actually it isn’t. Remember that the maximum deviation from the mean is 4SD or Standard Deviation. The SD for the NBME as far as I know is about 10, so 4 SD is 40 so a drop of 20 is possible. But if you notice, the mode of the scores is in the 240 range. having 1 outlier is not significant.
Askdoc
Hi,
I am an orthopaedic surgeon preparing for USMLE to get into fellowship.
I did NBME form 1 to 6 offline and got around 91%+?3%(doubts).
Am i ready for exam?
I am planning to take exam by end of may2010.
thankyou
Hi chanduortho,
First, the offline or actually pirated version is not very reliable. Please read my post NBME Self-Assessment Tests and USMLE Review – an Update. First, because the answer key may or may not be correct. Second, different forms have different equivalent scores as they are correlated and curved. So raw scores are not very meaningful without the correlation and curve.
However, 91% is high. based on available curves it would be mid to high 90′s depending on the form you are using. But again, the reliability of the answer keys are crucial.
Askdoc
Hi,
This forum has been really helpful. I just want to know more information about scoring. Especially the 2 digit score. I just received my score and got a 98 I was very happy but really confused as to what it meant. Specifically what is the difference between 99 and 98 in terms of residency specialty options? I know if you want to do something extremely competitive 99 is the only way, but what is a 98 good for?Also there seems to be a range of 3 digit/2digit scores. Does the 2 digit reflect difficulty of the exam if one person scores in the 20s and another in the 30s but gets the same 2 digit score? Thanks for the help!
Hi,
I dont know if it is wise to go ahead, took NBME 4,6, UW SA 1, 7,5 and had 201,19819,209,207. my goal is 240. I need advice.
Hi Happybutconfused,
I can understand why you are happy and why you are confused.
Anyway, there is very little difference between 98 and 99 actually, but psychologically it has an impact on how people see you. and this can make a difference during interviews when sometimes competition for positions are so competitive every small edge counts. Anyway, the reason for a 2-digit and 3-digit score has to do with how USMLE evolved. In relatively ancient times (the 80′s) there were 2 exams. NBME for AMG and FMGEMS for IMG. NBME was reported using a 3-digit score while FMGEMS was reported as a 2-digit score. When the examination was consolidated into the USMLE sometime in the early ’90′s both scores were reported so as to make the scores comparable to earlier groups. Hope that clears things up.
askdoc
Hi R.E.,
I’m sorry to tell you this, but those scores are not too good. You still have a chance of failing this exam. even if you pass it will be really low. $ days is not enough to raise your score.
Askdoc
7 days until my exam… its really hard to shake the stress at this point… i scored uworld 65% 1st time around 78% second time around… i took u world self assessment 1 4 weeks ago and scored 212.. I took my second assessment (form 2) today and scored 244(79%,79%,62%,74%… i am happy to have good up but i am really worried about my inconsistency… in the third block… NBME 6 240
kaplan qbank 1st time around 69%(beforeuworldq’s)
A friend of mine who took it in june scored 200(didnt freak out, understood q’s and was baffeled by difficulty)… and he had relatively230-250) hi scores in his assessments…
205 is really close to failing now that passing is 188..
I also took the cbt 2011 practice test off of the usmle official website and scored 80%(80 80 79 81)… i thought that this test was really difficult and was really impressed by the detail of the questions… im curious as to the how this test correlates with step 1…
any thoughts as to how manage my stress???
hi 7days,
I’ve always said that the exam is tough and the questions are very detailed. It’s just really hard to convince people of that fact since it seems most forums are recommending that reading FA a few times is the key to scoring a 99.
Anyway, a little stress is always good as it keeps you alert. Too much stress however, is bad. In my case I stopped studying 3 days before the actual exam. Watched movies, comedies mostly. Took a warm bath the night before. Made sure no caffeine for breakfast, just a light snack with high sugar content. Took beta-blockers. In the end, you need to have the attitude that you’ve done all you could already by the time you sit for the exam and worrying about it will not raise your scores but may even lower it. If you want to know more about what you need to do for the exam. Read my post on What to do on the Day of the USMLE Exam
Askdoc