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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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105 comments to NBME Self Assessment Tests and USMLE Review

  • 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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