Master the USMLE Step 1



NBME Self Assessment Tests and USMLE Review

The NBME self assessment test is another of those tools that I feel is responsible for the increasingly high scores in the USMLE. It is a great tool that allows the test-taker to assess his or her readiness for the exam. To a certain extent, if used properly, it is also a useful tool for the examinee to target a certain score, even 99’s and achieve it.

How the NBME Self-Assessment Tests were Designed

The questions for the NBME self assessment tests were taken from a pool originally designed for the shelf exams of American Medical Student. As such it covers the most important concepts that AMGs are required to know before passing to the next level. It covers the same topics that will be covered in the actual USMLE examination.

The NBME self assessment tests are very good at predicting the score you will get at the USMLE. In fact I read somewhere (unfortunately, I can’t seem to find the site now though) that at least for Step 1 the 1st exam set has a correlation as high as + 0.89, while the others range from + 0.72 to + 0.85. If you go to most of the forums, you will find that the correlation for most examinees is very good.

Difference Between NBME and USMLE

Although the topics covered in both the NBME and the USMLE is more or less the same, there is a tremendous difference between them.

First, the NBME questions are much, much more straightforward than the USMLE questions. The NBME has precious little tough questions. Therefore a low score in the NBME is more indicative of lack of knowledge of the topics covered in both exams rather than a lack of mastery of those same topics. Although the latter exam sets have tougher questions than the first sets, they still are not as tough as the tougher parts of the USMLE, plus, they actually have lower correlation with USMLE scores than the first exam set.

Second, the NBME questions total less than the actual USMLE exam and therefore will cover less lower-yield stuff than the actual USMLE exam.

Third, you can have up to 4 hours to answer the examination. Part of the toughness of the USMLE is the time constraint imposed on the examinee.

Fourth, you can take the blocks at a time of your own choosing, usually during periods where you are at your peak effectiveness. The actual examination does not give you such luxury.

Fifth, you have to take the USMLE blocks, 7 to 8 at one time with minimal breaks, which can take its toll, believe me. By the fifth or sixth block, your mind tends to stop functioning. You have only 4 blocks in the NBME and you can take it at your leisure.

NBME Self Assessment Tests is a Good Predictor of USMLE Performance

So despite the obvious difference between the 2, why is the NBME such a good predictor of USMLE performance? The answer lies in the fact that the NBME has taken the time to correlate the results of hundreds of thousands of AMGs with their actual performance in the USMLE. This correlation has taken into account the difference in test conditions and actual content of the examination and that this difference although apparent is not very significant as can be shown by the correlation of + 0.72 to + 0.89 between the various NBME exam sets and the USMLE.

Ineffective Use of NBME Self Assessment Tests

So the practice of using the “downloaded” version of the NBME tests effectively wipes out the predictability of the exam set itself. It’s effectiveness lies in the statistical analysis they’ve done for the results and not the results themselves.

Another ineffective practice, is studying the NBME test questions to improve your score. This will be effective only if your original review is so poor that you have not covered the required high yield topics tested in the USMLE properly. Otherwise you are better off studying the questions in USMLE world and Kaplan Q Bank to understand how to answer tough questions and low yield stuff that are more likely to appear in the USMLE.

Another common error is repeating the exact same exam set. The correlation holds only if you take the exam once and only once. Repeating it will raise your score in the NBME which will not be carried over to the USMLE. Therefore, I suggest reserving at least one set to be taken only if you are ready to do the USMLE.

Used properly, the NBME tests can be an effective tool for self-review. So do yourself a favor, use the NBME self assessment tests properly as an assessment tool rather than a study tool. And take the online form rather than downloading them, which is also subject to copyright issues. The NBME self assessment site is here.

*note: Part II deals with When and How to use the NBME self-assessment tests and whether it is wise to use USMLE World self-assessment tests instead. Part III is an update of this article.


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106 comments to NBME Self Assessment Tests and USMLE Review

  • Kalpana

    I am new to NBME but have heard a lot about it. Can you please tell me more about it , like – how do I subscribe to it? how many questions are there and do they come with the answers. I tried to google for it but was not able to get the questions that you have written about. I will be giving my step 1 next month so I will appreciate if you can help me out.

  • hi kalpana,,,,,

    first of all i want to wish good luck for ur exam next month. try to got through the official website of and there in the home page you will have details about the self assesment exam and the cost and purchase deatils. make sure that you use the modules u have purchased in 20 days as the validity peroid for this service is just a momth…



  • snehal

    i am done with my 3 reading of kaplan. 1 reading thru 1st AID. and planning to appear for exam in april or may. will nbme help me in ny improvement?after all these study, i m still not that confident abt appearing for exam.what u say guys plz help me out…

  • Hi snehal,

    The problem is that everyone read Kaplan and First aid. Some get 99’s other fails. It’s not what you studied but how you studied. NBME won’t improve your score. It just tells you if you studied effectively, or what you studied went nowhere. There are many people who studied for months and still fail. Take the NBME to know if anything you studied did stick in your head.



    hai…thanks for the valuable suggestions, i would llike see the model question papers (practice papers) to practice for the exam.

    thnak you

  • docjay

    hi askdoc,
    im done with kaplan and firstaid reading. almost done with usmle world ( my score is 50-60%). how should i acess my preparation? any other suggestion?

  • Hi Docjay,

    First 50-60% in UW means average of 55% which means failing in the actual exam. 58-59% is needed to have a good chance of passing although not a sure pass. The question is how many times did you read kaplan and first aid? How much information did you absorb? Most people with good memory and comprehension needs at least 3 readings of Kaplan in order to pass this exam. This means they are able to retain at least 65 to 70% of what they’ve read. Some people may need to read through them at least 5 times and comprehend and retain the information to pass this exam. So you have to ask yourself first which one are you and how many times you have revised the material.


  • amer

    Hi askdoc,

    What you are saying appears very ture for step 1 and 2ck, but for step 3 it seems that the NBME is not a very good tool of assessment.
    do you agree with me ? what would you recommend ?



  • docjay

    hi askdoc,
    im done with my usmleworldq bank I strtd with tutor mode but last 60% i solved mixed unused timed mode. my score is 68%. i have my exam next month. anythin else i need to do for CK prep.

  • Nerd

    btw! quick add… I took all the NBME’s purchased online except #5!
    My bars on form 7 were all the way to the right and I had 3-4 stars on some of them….complete opposite of 6…which was all the way to the left!

    Ok thanks :)!

  • Hi docjay,

    68% is not bad. you’ll be getting somewher between high 80’s to mid-90’s for CK. At this stage if you are happy with that score, I believe, just high yield review and more mixed, random, unused timed blocks will help.


  • priya

    Hi , I got b/w 75-77%in my nbme practice sample paper and getting arond60% in kaplan q bank for step 2 ck. I mostly focussed on questions this time rather than reading books… am i ready for step 2 ck?

  • docraj

    hi ask doc,
    i cleared step 1 with 237/99.will be getting ck results in this week.looking for internal medicine residency. i gruaduated last year and didnt get into practise and have no clinical experience or reserach. what are my chances?

  • Hi priya,

    depends on what is your goal. If it is just to pass with a low score then I think you are OK. Again do the NBME online, not those downloaded edition to get a better gauge.


  • Hi docraj,

    depends on where you are applying, Apply smartly and you will get interviews, lots of them. But interviews can make or break you so its important to do that well too and not just depend on your scores. Make sure you research the programs you are applying to. Applying to the wrong programs will actually do you a lot of harm


  • docjay

    hi askdoc,
    my score in step1 237/99 and step 2 ck 241/99. how do you find it for neuro and IM residency? but i dont have USCE or research papers.

  • Hi docjay,

    If you are fresh grad, that should be no problem. Just make sure you research your programs carefully. Not all programs require USCE or research experience. Having both just means you can apply to more programs that is all. Find programs that do not really need either.


  • smita

    Hi askdoc,
    I read in one of your answers above that at least 3 readings of kaplan are needed. I am finishing 2, but with a gap of 3 months between these two readings. Also I am yet to finish even the first reading of First Aid. I am scoring around 65 in uworld. I don’t have much time and doing a third reading of kaplan looks impossible. My progress on uworld is good, with recent tests showing 70,72,78… I aim for a 99..What do u suggest?

  • Hussayn

    How can I contact the administrator via Email? I need to ask questions!!!

  • jgrew

    Hi, askdoc,

    Hope you’re well. Just got my Step 1 score: 237/99. I am an SGU student born in New Jersey who will begin clinicals this May/Jun 2010. I am just wondering what my marketability is like for a general surgery, anesthesiology, or pathology residency. What are the “good” residencies that are attainable based on my Step 1 score? Very much look forward to hearing from you at your earliest convenience. . .

  • Hi smita,

    First, you do not need to do 3 readings of Kaplan Notes. You just need to do 3 revisions and revisions does not involve only reading, but memorizing and integrating what you have read. The first 2 revisions may involve something as detailed as Kaplan notes, but the 3rd or subsequent revisions can be limited to higher yield materials like First Aid or any notes you have made when you were reading Kaplan Notes. 65 is USMLE world is high 80’s to low 90’s. your current scores is enough for high 90’s but not yet a 99. I suggest you concentrate on high yield material and see how high you go. You need to consistently score above 76 for last 10 blocks random, timed mixed in order to be sure that you will get a 99. Whether you use a new qbank or just study the material you have and not do any questions depends on how near you are to your goal at that time.


  • Hi jgrew,

    Actually very hard to assess individually on your chances since too many variables are involved. First is Step 2 CK scores are also very important in getting residencies specially for IMG’s. Anesthesiology is extremely competitive and you need both good scores, some “influence” and lots of luck to get in. GS is easier than anesthesiology and having USCE and no visa problems will help a lot. You still need a good Step 2 CK score though and you need to choose programs that like or fit your credentials. I do not know the competitiveness of pathology or what criteria is important. So I can’t help you there.


  • yesme

    Hi askdoc,
    Just took step 1 exam and I was shocked to see I had 8 blocks on my test. I was surprised because I always thought there were 7 blocks in the 8 hour time period. Am I missing something here? I know that the exam is constantly evolving, is this one of the changes for this year? Really need some answers

  • yesme

    Sorry about that, just found out that the tutorial is considered 1 block even if you decide to do it or not

  • Hi yesme,

    No Problem. Happens to everyone.


  • TNL

    Hi askdoc,

    I was wondering what is a good percentage to be in for UWorld that would correlate to passing Step 1? Thanks so much.

  • Hi TNL,

    You would need about 58% random, timed, mixed unused blocks to have a chance of passing Step 1. If you want to make sure you pass, 60% would be better.


  • mana

    iam studing for step1 over year, my first blck in usmle was 40% after that i reach 64% then i stp doing blocks and i did revesion for sme topic ,when i did blocks after this reveision i got low scores,why.please help me iam gona loos my mind

  • Hi mana,

    If you listen to my introduction to the prep course. You will understand that studying too long is actually detrimental to doing well. That is due to the fact that we start forgetting what we have studied almost immediately. So long as our rate of learning is faster than our rate of forgetting, you are adding to your knowledge. But going too slow can result in the opposite effect. When rate of forgetting equals rate of learning you have reached what we call a plateau. Everyone plateaus eventually. Some plateau at 99, some at 90 some at 75. You don’t want to plateau at a failing score. If after plateauing you continue to delay your exam, you start going into decline and your actual scores become lower. For most people optimum study time is 6 to 9 months. Some of course can study longer before plateauing but they are the exception rather than the rule.


  • mana

    so, what i have to do now,my scores is still go down and you rigth iam starting to forgot a lote. and i can not go to exam untill august 2010,and i want to get 99.
    thank you so match

  • mana

    If i did another revesion for the kaplan notes ,first aid q bank kaplan and usmle world ,is my scores will increase ??
    thank you

  • Hi mana,

    Depends if you are declining. If you are then you need to take a short break before restarting your prep and do one more revision. Start with kaplan notes, then qbanks then first aid. As to getting a 99, that may not be possible given the maximum you achieved in q bank was a 64. You need about 72 to 75 to have a chance at a 99.


  • Hi
    I’m preparing for my step1, i used kaplan video/notes, read first aid 2 times, did u-world on tutor mode subject by subject for all the unused questions. my average score is 55%.Then i started mixed, timed questions of the used questions. i have done 11 blocks and my average score is 76.63%. my exam date is in 2 weeks. i have not done NBME. Pls what do you suggest? I’m worried bicus i want to get in the 90-99 % score. thanks

  • this is how i did in the 11 blocks: %..70, 68, 72, 83, 87, 77, 75, 75, 72, 81, 83. ..time mode, mixed questions, but used questions…thanks

  • Hi Immanuel,

    I am sorry to inform you that using used questions is completely useless in assessing your ability to pass this exam. With an average score of 55%, your chance of passing the USMLE is low. My average on qbank was 84. When I redid questions my average was 99%. I got 99/256 which is about where you would be if you got 82-84 in qbank. If 99% was my true score I might have gotten a 99/incredibly high-break all record score, right?


  • Hi
    Thanks very much for the reply. So in this case what do you suggest I do? Thanks

  • Hi Immanuel,

    You have two choices. Do an NBME to confirm the score you will get if you decide to continue with your exam. Or you postpone your exam. Restart your review this time do your prep properly. It is easy to tell by the way you prepared that your chances of passing this exam is very poor. If you read my posts, you know that the way you prepped was completely wrong.


  • Thank you very much. I have subscribed to the nbme form 1. i will take it tomorrow, 10th july, since the date of my exam is on the 20th July. if it doesn’t go well , i will postpone it to a later date. What is the best month/date to take the exam? thanks, I appreciate what you are doing. thanks

  • hi Askdoc
    thanks for the good job you doing.
    I am confused. I took both the usmle world assessment test form 1 and the NBME form 1 today. I got 490 ( a digit score of 216) on the usmleworld assessment , but a very low score of 200 on the NBME assessment score.
    Honestly, I started studying for the exam from the 3rd of June 2010. I have scheduled my exam on the 20th of July 2010. However, looking at these scores, I guess I don’t have a chance of passing the exam. So I will postpone it. I was hoping of finishing the usmle exams in time so i could apply for residency this september. I have not written any of the exams( i have registered for all of them though)..

    I can see my chances are very slim.

    Please, Please,.. tell me how I should study for this exam step1. The only materials I have are KAPLAN VIDIO LECTURES, KAPLAN NOTES, FIRST AID2009, GODJAN AUDIO. USMLE WORLD QBANK, . Will I need special classes or I can study on my own?. AND DO I have a chance of applying for residency this september or I should just plan to apply next year and use the period between now and next year (2011) september to write the exam.

  • Hi Immanuel,

    You studied the right materials but you have problems about studying the right way. You need to get someone to help guide you in how to study properly. If you want to make it to 2012 match (September 2011) then you need to be starting your review now. Take Step 1 in January or February. Step 2 CK in August. And Step 2 CS somewhere in between around February or March. I don’t think you can study on your own at this stage. Whether you enroll in a course or not is your decision. But you obviously need help.


  • Hi dr ask

    Thanks for the good advices. I finish uworld q bank with 50% 2 months ago , now im doing USMLE RX getting 60 % , but im thinking in buying qbank . Or maybe do uworld q bank again ( after do the unused i started doing used and incorrect and getting 87% 85% 90% ). What do you suggest buy a different qbank like kaplan or do again uworld? and sincerely what do you think about usmlrx?

    thank you so much.

  • I needed some advice before i go and attemt my USMLE Step 1 exam, I hope you can help me. I started studying for the exam march and i have allready went through Kaplan Lec notes for (patho, pharm,biochem,immuno,micro) also done the Kaplan video to those subjects as well. Then i have completed Goljan rapid review for Patho as well, Also First Aid 2009 i went through it atleast twice and i added notes to as i went along. Then i finished UWORLD Q bank and Kaplan Qbank, as well as rapid review question banks and now NBME questions as well.

    Even after all this i am still not at the level i should be i just dont know what i am doing wrong and now i am getting depressed cause i cant seem to bring my score up anyhigher than what is. I was planning on taking the actual exam beginning of AUG.

    PLease give me some advice, please help me in some way. THANK YOU SO MUCH.

  • Hi Hi dr ask,

    I suggest you use a new Qbank. Kaplan would do nicely. The problem with reusing qbanks is that what you have learned is the question and not the concept behind the question. Therefore that question cannot accurately assess your understanding of that particular concept. Although, I have not personally used USMLERX, I have seen some of the questions and they are not bad. However, both Kaplan and USMLE World still have the most statistical data to back their reliability for helping you get ready for the USMLE. I would still recommend you use either Kaplan or UW and use USMLERx only as additional material or resource. Same reason I recommend my own Step 2 CS course only as supplement even though I have taken pains to make it into really good prep material. :) Best to rely on a proven resource first and use newer resource only as supplement.


  • Hi Hi askdoc,

    Before I can give you any clear advise, what was your scores in UW, Kaplan and NBME. And did you use the actual online materials or did you use the downloaded version. Plus, how many times did you go through the notes and lectures and in what order.


  • usmle100

    Hi askdoc….
    I ve read kaplan,fa, uwQbank,i ve done kaplan n usmlerx q bank,subject wise…now i did nbme form 1 offline ,but i got 50% of qs correct..wht can i do to improve my score. I ve now started reading goljan rr3rd ed,i also did his audios some time back.

    wht can i do to improve my marks?? plz let me know,i m planning to take my step in aug end. thnaks

  • nathan

    hi askdoc
    just finished my studies with 64 in uworld,310(188) in nbme form 4 then 390(201) in nbme form 2
    my exam on 29th july dont know if i can give USMLE.kindly help

  • Hi usmle100,

    If you’ve read my posts in the blog, you would realize that you used all the study materials in exactly the way I said you should not. That is why you are having such problems. I do not think you can be ready to do the exam by August. Revising Kaplan notes alone will take at least 4 to 6 weeks. Basic mastery phase for step 1 involves at least 3 revisions. First revision you use a detailed study notes like Kaplan or my online Study notes. And revision does not mean to read. It means read, retain and recall at least 80% of the material. For some people that involves reading once (they have photographic memories) for most others it involves reading more than once. Second revision involves using high yield outline notes like BRS or FA but coupled with more detailed study notes in order to insure that you have not forgotten the more detailed material. Third revision involves concentrating on high yield outline notes like FA or BRS. Only then do you do qbanks, never subject wise but always, random, timed, mixed unused. This is the time period you identify weak points in your study and systematically take care of them. Then you do an NBME then sit for the exam 2 to 4 weeks later and pass it with at least an average score or even higher. As you can see, you need a lot of time to be able to do this. Students in my prep course follow this general outline of review and prep and most of them do get to get their desired scores. You need to reboot and do it right this time.


  • Hi nathan,

    I need to know how you did uworld. Is it timed, mixed random unused. As a 64 in Uworld is usually correlated with a 215 to 218 in NBME. Based on your current NBME result you have a big chance of failing. If you happen to pass the exam your score will be at most high 70’s. Usually when this things happen, it is because you did something wrong in your prep. If you read my reply to USMLE100, you will see how to prep for this exam for maximum effectiveness.


  • mana

    Hi dr. askdok
    Idid NBME 7,and for some reason i didnot finish all blocks ,i finsh just the first block and i got 200,200 in just 1 block is that good or it is not assesment

  • Hi mana,

    200 is the lowest score you can get. Even if you get 0 questions right, your score will still be 200. So not assessment.


  • dapo

    i took nbme step 2ck 3 and scored 202,examin a week,what do you advise

  • Kemi


    I am preparing for step 2 ck. My average on uworld is 68%. My scores tend to range anywhere from 73 to 64 when I do my blocks. I have 20% left of the u world to finish. I did he NBME two days ago and did not pass. I am so confused because I thought was doing well enough to pass with a decent grade especially with my scores from uworld. My exam is literally next week and I don’t know whether to move it or just concentrate on the areas I did badly in from the feed back on the NMBE. Any suggestions please

  • Hi dapo,

    You can pass, but you can also fail. It is not a sure pass. Even if you pass it will be very low. So depends on your goal. If you are aiming just to pass and you can afford to fail. You can proceed. If you want a sure pass or a higher score, you need to postpone and redo your prep in the correct way.


  • Hi Kemi,

    I need to know how you did UWorld qbank. Was it all timed, random, mixed unused blocks? If not then there is a problem. I need that information in order to further answer your question. I also need to know what NBME form you did and what your actual score was. I suggest you postpone as the NBME is usually very reliable.


  • Kemi


    All the blocks were mixed/random and timed. On the NBME I got a 191 which was for the second nbme. It showed me that my peds and surgery were poor. Reviewing those intensely as well as other areas in IM that were not too strong. I plan on retaking the NBME on Friday/Sat.
    Do you think that’s a good idea.



  • I just took NBME 1 and got a 550/229 according to NBME.
    Really, I want to score a 99 on CK, but I have only a week
    to go. Any suggestion on how to proceed ?



  • Hi Kemi,

    My big problem is why there is a big disconnect between your Qbank result and your NBME. Based on your qbank you should be hitting 210 to 220 already and yet you got a 191. That’s around 3 standard deviation down from where you should be. Usually this happens for 2 reasons. One, you tend to panic when under pressure, this could result in a lower score. A second reason is that its a fluke and a second NBME would show a score nearer to where it should be based on qbank. However, I know there’s a feature lately at least in Kaplan that allows you to choose easy average or hard questions. If your score is based on easier questions, then that could explain the discrepancy. Your strategy is sound. But if you get a low score again, you may have to consider postponing your exam.


  • Hi caputsuccedaneum,

    Very hard to make recommendations because I don’t know what you have already done. Concentrating on high yield the last week can help boost your score, but not enough to get a 99. So its up to you. 99 is still a possibility but not likely.


  • My prep consisted of USMLE World + hard studying during the Core rotations. I have recently started reading STEP-UP. My UW average is 79% second time through. I went through the first time over the last year. NBME 550/229. I understand I need to get to 600 for 99%. Any suggestions ?


  • AskDoc,

    Actually, I don’t know if I have energy to push so hard for another 5 days to conver the differenct between a 550/229 and 240, which should be a 99, correct ? I’m exhausted. My electives are lined up ERAS is done and I finish in December. I have a grad degree and several (hard science) publications plus some other things. I made 92 on Step 1. Is 99 really that important for someone like me looking for an IM residency ? I don’t know. Please let me know your thoughts. If you advice so I will probably push the exam out a month and put thumb screws back :).

    Thank You,


  • Hi caputsccedaneum,

    You forgot a u. :). Actually depends on the program you are after. A fresh grad with 90’s in both step will not find it hard to get interviews. If you need visa, you’ll probably get about a 8 to 12 interviews. If you don’t need a visa, easily 15 to 20. But research your program well and do not apply to really competitive programs where you know double 99ers tend to congregate.


  • Thanks for your help Askdoc.
    We appreciate your forum and advice.

    – Caput

  • Kemi


    I did not take the NBME a second time. I just studied the areas I was weak in intensely. I just got my score today and I got an 86 (207). Not what I had hoped for but I am content considering that I really freaked out and wanted to move my exam back by a whole month. It paid off because I did very well on both peds and cardiology which the NBME showed I was weak in. I still did not do to well on Surgery (never liked it and not surprised). At least I can apply for the match early and I believe it will all work out.
    Thanks for taking the time to respond to my questions and your honest opinion.


  • Hi Kemi,

    Not bad. Wish you luck on the match.


  • Muhammad Umer Siddiqui

    Hi..I did uworld self assessment forms 1 and 2 and got 261(1) and 254(2) about 2 weeks back..Today i did NBME form6 and got score of 550(234)..Why is there such a difference??While doing the form6 I didnt find it harder than the uworld but still I ended up with a score less than the uworlds..My real exam on 30th sept..any advice??

  • Yolanda

    I have been reading opinions on the accuracy of the usmleworld self assessment for step 1 and 2,, what about Step 3?

  • Hi Muhammad,

    Remember it is not a question of how hard the exam is. The actual score is a curve and based on correlation. So you need a lower percentage correct for a tougher exam to have the same score as an easier exam. The question is whose curve is more accurate. There has been a lot of complaints on UW over-estimating your scores. So I would trust NBME more. Advice for exam, take it easy. Do only high yield review. Stop studying the day before the exam and just rest. Read my post on What to do on the day of the USMLE exam. Good luck. You will have a good score.


  • Hi Yolanda,

    No idea on Step 3. Never used it in my own Step 3 exam and have no feedback from other people who took Step 3. Sorry.


  • DBL

    Hey askdoc

    So, I took the Step 1 on July 23rd of this year, and didnt pass, I have been restudying since and focusing more on Qs using Uworld, and FA and I have completed the DIT course which also uses FA as the text. I have Goljan audio but have just begun. I have not chosen my date yet for the next try but i am scheduled between now and december 31st….i am currently scoring..well stuck between 52-60 on my uworld and just took NBME form 2 and scored a 310 (181). I review all my answers and can honestly say that i have the potential to truly score within the 70s on Uworld, i say this because when i review them i add those questions that i hit myself in the head saying why did i choose that, i knew that! and mostly always the wrong one out of literally 2 answers when narrowed down. I guess i am not confident in my answers, but i do know the material. bad excuse, but I am a horrible test taker, especially an exam like this, but I am great in the hospital when an attending is grilling me. I dont know what to do. I am at this plateau and trying to break through. Even the NBME i took, when I reviewed what i got wrong there are a few that “i knew” just wasnt confident in, but i still managed about 70% correct in each of the 4 blocks. What do you recommend I do? Anything is greatly appreciated. I know i have the potential to do great…i just cant get to doing it!

  • Hi DBL,

    You need to master the concepts you know. You need to memorize them in more detail than you have done so far. That is your problem. Usually when you are always down to last 2 and can’t answer, the problem is either lack of understanding of the concept tested, or you have not memorized the concept enough so you forgot some details needed to really get the right answer. In most cases, it is the latter problem. Remember, if you know and memorized enough detail, you can eliminate one or the other.


  • themis

    Hello, I have been studying for the step 1 from April that is about 7 months. In the beggining of September, I took NBME form 7 and scored a 440. At that point I had an average 66% on UWORLD Qbank. Then after intense studying and many questions 3 days ago I scored at NBME form 3 570 (238) with a UWORLD average 70%. My question is how much should i trust myself to score a 99 on the exam. I have 400 questions left on the QBank and I don’t know how to proceed. Thanks in advance for the feedback!

  • BPositive

    First of all thank you so much for taking your time our and helping us… I need your guidance please.

    about me – Caribbean medical graduate 2010. trying to teach my self and learn as much as I can to do best in exam and future. I am average student.
    My goal – to clear step I in first attempt with at least above average performance. 88<
    Studied for 5 months….
    resources – Kaplan books and video (done), MedEssential,
    FA 2010 use as I do questions. not done yet
    Rapid Review read once, will read again with Audio lecture
    Uworld (not done), and NBME (took I paid version to evaluate my self and did horrible)
    also used skype and face to face study buddy but it can be time consuming and drama series with one way road.

    Now, Currently last reading for Kaplan and easier on my self doing usmlerx. But I am wrong somewhere.. cant find out where? I did Kaplan Qbank score 55. There was time when i used to get about 60 < consistency was there. I was getting slowly confident and improving. Suddenly couple of times family/friend/study buddy said i am guessing my answers most of the time, I dont know my material, and i m working hard enough and don't have confidence.. ;-(

    I took NBME I paid version few days back – I wanted to see where do i stand after months of preparation… but I got lowest score. (failed) Everything was very familiar but end up performing very bad… I do have test anxiety but it shouldn't matter if i know my stuff… so i feel I am still on learning phase after 5 month of study.i am scared and confuse. how should I modify my strategy or habits? Should I read Kaplan books one more time??

    Please also tell me if you are available for mentorship? or do you have any program which i follow to kill this exam? I have clean transcript so far I don't want to contaminate it. please guide me. thanks.

  • Hi themis,

    The NBME predictive score is alwasy +- 10 to 12 points in the 3 digit score. The correlation is never 100%. Therefore although you have a chance of getting 99, it is not guaranteed. You are more likely to score high 90’s. However, for some people, studying high yield stuff in the last two weeks can add a few more points, So 99 is still a good possibility.


  • GP

    hi askdoc,
    i just finished uworld with a 62…also just finished form 3 of NBME and scored 340/188….im registered to sit for step 1 end of this month….how can i improve? do i have a good chance of passing?

  • may

    how do u get the practice test started??
    i cant seem to find the right link…

  • Dr.H

    Hi AskDoc,

    I am taking Ck in 2 weeks. I have been scoring pretty well on UW with 64% correct questions. I took UW self assessment 2 weeks ago and I was happy to get 233. Today I took NBME 2 and was shocked to get 207, way below my target.

    As I mention my exam is in 2 weeks and I am not sure anymore where do I stand?!

    Please advise

  • Hi themis,

    You have a chance of getting a 99 but it is not 100%. It’s usually +- 10 points so you can still fall below 99. Just continue doing the qbanks and do high yield review and see how high you can go.


  • DBL

    Hey just an update…my scores came in today and I PASSED! 234/95! What an improvement…I couldn’t be happier! I guess this exam is really a crap shoot, not only do you have to know your stuff but also its just your luck on what questions you end up getting….i learned this the hard way. Anyways, thanks for your help!

  • DesmondQ

    Hi AskDoc-thanks for the all the insightful comments!

    I have been reviewing for Step 1 for the last 6 weeks and have completed about 50% of UW questions with average score of ~55% correct. Took NBME#5 this week and scored 410/203. Exam is in 2 weeks. I felt familiar with all the concepts but thought I need to do some memorizing to lock in on the answers. I haven’t really been through FA yet due to getting bored every time I start a section-but I have read BRS physio + path and about half of Goljan RR. Can you please give your opinion on whether I can do enough hard core review in the next weeks to score ~230-240 on the real test or should I put it off for another month or so?

  • Hi DesmondQ,

    Basically you cannot raise your score to 230~240 in 2 weeks. Not possible. Next going into the exam with a 410/203 and there is still a chance you will fail this exam. I suggest you continue your prep, but if you don’t hit at least 215 a week before the exam, then postpone it as there is a chance you will fail.


  • Hi DBL,

    You are welcome DBL. That is a nice score. Good luck.


  • TJ

    Ask Doc,

    Been reading your posts and am impressed with your knowledge. I just took my first NBME assessment test and got a 300 (179). I am taking the Step 1 in May of 2011 and will be taking Kaplan review in the meantime. So I have about 5 months of intense studying ahead of me. What sort of improvement do you think is realistic? And should I be taking these NBME assessment tests each month?


  • Hi TJ,

    Very hard to say. Not enough detail to base my assessment on. You need to read my blog in more detail, so you can assess yourself base on your own strengths and weaknesses and situation. And if you really did read my articles, you know you should not be taking those assessment tests monthly or even when you started your review.


  • Jamie MacIver

    Our school has instituted a new policy that requires us to write the NBME and score a 650 before being allowed to write the Step 1. If a score of 600 is equivalent to 99 then what chance do we have?

  • Hi Jamie,

    It depends on how many geniuses are in your school. But if they are comparable to most Medical schools, I would say only the top 5 to 10% of your class will be allowed to take the USMLE Step 1.


  • ram

    hi there i hope you can help me out.I have been working very hard for past months.finished u world q bank and kaplan study material and i got a very good score of 233 and 236 on u world self assessment but i could not bear my disappointment when my nbme form 7 score stooped down rapidly to 460 and 455.I really dunno whats wrong.I was given a report that I got 150/200 questions correct.So does it mean that we should get almost 185/200 questions correct for getting a score of 550.i really dunno what much more to read than this as all my text books are literally in shreds and pieces.please help me why am gettin a low score like of now doing first aid but dont seem to be gaining new info as i am already ok with usmle material.please DO HELP ME..MY EARNEST REQUEST..WHAT COULD BE WRONG?DESPERATELY FIGHTING MY DEPRESSION

  • Hi ram,

    First, you are right. You need about 96 to 97% of the questions right to get a 99. Next, uworld self-assessment tend to overestimate your actual score by a very large margin. Lastly, just reading the textbooks multiple times is not enough to score really high. The question is how well have you integrated the topics you have read. Another problem is have you studied the material in the right level of detail and be able to recall them in a timely manner. And lastly, how analytical are you? Doing First Aid will not help.


  • lakshman

    hi askdoc
    My Usmle world score was 69%, UW self exam score was 213/nbme form 1 was 250..nbme form 2 220…my final exam score 256/99.quite thrilled thanks for all the help

  • Hi lakshman,

    Great Score, congratulations. And you are welcome.


  • Bella

    HI ASKDOC.. i m not sure if u remember me.. i asked for your advice last year in september..i had a poor step 1 correlation and i took your advice by taking a break and postponing my exam.
    I started almost 2 months later, and now i have my exam 10 days away..on this 31st. I took my nbme form 6 online and i got a score of 500/223
    i would appreciate your opinion on the correlation of nbme 6.. i m also wondering whether or not i should take another nbme to confirm my score projection and if yes.. i need your suggestion on which nbme has a better correlation between 4 and 5 as i have used all other on previous ocassions.

    Thanks in advance.. and your blog is just great.

  • Dreamer

    Dear Askdoc, first of all, I want to thank you for taking some of your precious time to answer us, truth seekers, on your valuable website! words can never adequately thank you enough :)

    I am an IMG who needs visa, I have been fortunate enough to get 262 in step1, and now i am in the process of taking step 2. I did NBME form 2 today and got 600 (which translated to 253 – this really comes in discrepancy with other people’s three digit score NBME correlation to USMLE correlation elsewhere on the net!!) … I have done 53% of UW qbank first time, random, timed and my cumulative is 77% thus far; My question to you: what is the best strategy now? should I delay my step 2 exam from the end of this month until (say june) to guarantee finishing UW qbank and perhaps do another NBME form (number4? what do you think?)? Do i (need) a score as good as my step1 in order to get into a decent internal medicine or pathology program (my two main passions), what is my safe margin here in your opinion?; I am treading carefully here, as i dont want to make any fatal mistake that might ruin my chances of residency in the US(especially in these harsh times were competitiveness is making the odds of Visa-needing IMGs grim.

    Thank you so much for your altruism and kindess

  • Zahid Bashir

    Hi everybody on ths forum.Iam a 2004 passout img.My step 1 score s 95 n i am preparin 4 step2.Do i mstand some chance of getting a residency?


    Dear Askdoc,
    I have read your blog and really learned from it. Thank you. I have attempted Step 1 twice and failed..1st attempt was a 178…2nd attempt 183. I study very hard and have read first Aid at least 3 times. My 2ND attempt was a month ago. I have been doing questions ever since. I finished and reviewed kaplan Q book and I am currently doing U-world. Even though I did u-world b4 the first attempt (finished Uworld that time and had an average of 51% correct), the questions still look fresh, so to my understanding I answer them now based on what I know now and not answers that I’ve memorized. I am using U world again for the weak areas highlighted on my last attempt. I average 65% currently on U world. I also took the USMLE STEP 1 PRACTICE Exam couple days ago with a score of 70%. My exam is in a week. I am working very hard to make it this time around. I plan to do NBME 12 in a couple of days. Based on my current stat, what would you advise me. I feel all I need to do is questions but I need your expert advice. Please help.

  • Hi Dreamer,

    Actually if you are aiming for a 99 in Step 2 CK, your margin is just good enough, of course it can’t be 100%. If you are a fresh grad IMG, your score is enough to get a decent residency program in both areas. If you are an old IMG, things may be a bit tougher, since you need a visa and getting into a decent program may be a problem. But postponing your exam may not necessarily raise your scores. If you are plateauing already, you may even experience some decline if you postpone. No it will not ruin your chances of getting a residency. But it can narrow your choices a little. So its still your decision.


  • Hi Zahid,

    Yes, you still have a chance in getting a residency. It’s harder but not impossible.



    Based on what you have told me, I have bad news. I think when you take your NBME, you will be disappointed. However, I may be wrong. I suggest you take an NBME form that you have not taken before. And base your decision on that. The USMLE Step 1 practice exam is so very easy. So 70% is actually low.


  • sumit

    I am first time visitor to this site. I have done my step 1 last year, and now planning to give step 2 ck on 9 th june.. i want to do NBME self assessment to check readiness for exam.
    on NBME site there are so many forms for step 2 ck, i am really confused whis=ch one to take. would you please advise which one i should take and what is the difference in these differnt forms.
    and also tell me approx. how much i must score in the self assessment to get 99 in step 2.
    Hope to hear from you soon, as exam is near so little worried.
    please do reply soon.

  • What2Do

    Hi AskDoc I am about to take the step 2ck in two weeks, today I did nbme form 1 and I did not pass, but my Uworld qbank was going good, same thing that happen to Kemi last year, sincerously I freak out, because is not correlated, my overall uworld is 65 and my average are between 62 and 72, and in Kaplan qbank was overall 52,,, I would have to say that I am really ansious everyday, but even thought I felt I that doing good during the test. I don’t know what to do if retake another nbme or postpone the exam,,, Help!! thank u!!

  • Hi What2Do,

    Did you repeat the questions in the uworld qbank or did you do them only once? That is important. Repeating questions can inflate your score so its not accurate. 52 in Kaplan qbank is a fail too. So if you studied the uw questions and redid them, that explains why you failed in your NBME despite doing well in uw qbank. If that is the case, then you won’t pass this exam. I’m sorry.


  • Need orientation!

    Hi, askdoc!

    I’m a new visitor on your website. I have many friends that had great experiences with your advices, that I decided to share my fears. I am an old IMG, like 8 years ago, I decided to start my preparation for the step 1 at the end of 2009, since that time, I think I do all the right things: read kaplan books (once), watched the videos(once), read FA (many times!!!), did DIT (twice), do uw (twice), but when a took the nbme No. 3, i get a score lower than 200. I have to said that I was not constant during my preparation (maybe that’s one of the problems):( I had to stop my studyings more than one time, since 2009, remained constant since september 2010. I finish, on a second round the UW with a cummulative performance of 56%, first time was 45%. I had a friend that recommended me not to repeat the uw, instead, complete the kaplan qbank and take another nbme. I made an extension for the step 1, which is completed on 30 september 2011. I would appreciate your advices base on your experience.
    Best regards!

  • hi Need orientation!,

    You need to study the topics in the right level of detail. Your second round of cumulative score in UW of 56% is completely useless as repeating the qbanks will artificially inflate your scores. My first round on qbanks was 84%. When I repeated it, I was doing 99%. My final score is 99/256 which correlates with low 80’s in the qbanks. So do yourself a favor. Learn how to prep properly or you will wind up failing this exam as so many people have done.


  • Paul

    Hi Doc,
    I’m an IMG. I need your sincere advice. I am preparing for my step one, which i’m planning to take at the end of Oct. if i am ready. I finished my qbank individual test scores (46 q set) were around 60% when i completed it and i scored 61% on qbank plus simulated test. Then i started doing usmleworld. As i hav some more time, i was doing uworld quizs off and on while reviewing stuff., 2 sets per time whenever i do it., now like 20 tests done. Cumulative is 56% so far..ranging from 50% – 73%. Today, i just wanted to test how my scores would reflect with NBME, i bought form 7 and took it online. Unfortunately, i got only 193 ( 390 NBME score). I was really really pissed off and sad. How come i got such a horrible score that i hv never thought of after studying several months. I felt easy and quite confident while i was taking this and expected i would score quite OK.
    The weak points i have found about myself – i have lost my momentum when i ‘m done with my Kaplan qbank and its simulated test last month and it’s expired now. I am quite afraid that i will use up my uworld questions before my exam. Actually i haven’t set a date yet. But i feel really low today with this set of NBME. As i have read your post, it points out where i am, not what i am weak in. SHould i find online answers and review it (form7)? or keep on with my reviews? I have read FA according to the page reference in qbank and reading chapter by chapter now. I have read Kaplan Lecture notes once. According to NBME assessment profile detail, i got very low scores in Physio, Patho and Histology.
    IN these days, whenever i review after taking quizs, i feel like i know stuff quite well, except some of those in Uworld. Is it possible that i dun catch up the tone of NBME ? I ‘m well aware that NBME scores prediction do matter a lot for me. i think i need to review FA again. Can you give me some advice how to proceed? I will only take it when i’m ready. I ‘m aiming for 2013 residency .

  • snowman


    i will be taking the step 2ck in 2 weeks,, as far as the nbme self assessment exams, what is the best way to take them ( continuously, study between , save for last, do right now, etc…) ??

    i have done horribly on the uworld , this is my last chance cannot postpone any longer,, all i am doing now is studying form master the boards 2ck and the uworld questions. any magical advice will do. thank you

  • hi doc,
    i have been a silent reader of your since i started preparation for usmle stepl 2..
    now my exam is 2 weeks far.
    i got uwsa and got 3 digit score of 247 and nbme 2 and got 221.
    please help me why there is much gap?what is the probablity of getting good score in sctual exam?what i need to do other than cover weak topic again?
    i wan to take one more nbme .what wil be better choice? nbme 3 or nbme 4?
    please give me your expert advice for my case that what to do?what wil be worthfuL in geting good score?
    please help me out

  • Amanda

    Hi Askdoc,

    When should I start doing USMLEWorld and NBME questions. I am halfway through my first year of medical school. I am shooting for a 240+ on the USMLE and I am willing to do whatever it takes to do well. Would doing practice questions the summer after my first year of medical school be too early (AKA would it be a waste since I would not have learned pathology yet?)

    Thanks a lot!

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