NBME

NBME USMLE self assessment

What Are NBME Practice Exams?

The NBME Practice Exams are self-assessment exams that medical students use to help them prepare for taking Step 1. It gives med students a baseline idea on the contents of Step 1 and provides accurate estimations of scores they should expect after they have taken Step 1.

These NBME Practice Exams are released by the National Board of Medical Examiners (NBME), the same body that administers the Step 1. It is developed by committees of content experts all across the U.S.

As of the time this post had been written, the NBME has released numerous NBME Practice Exams for all the three steps involved in the USMLE, namely:

6 NBME Self-Assessments for Step 1 (forms 18, 20, 21, 22, 23, 24)
3 NBME Self-Assessments for Step 2 CK
26 NBME Subject Exams for Shelf Exams
1 NBME Self-Assessment for Step 3
To give you a more comprehensive idea of these practice exams, here’s a sample content outline as provided by the NBME. Take note that this is not limited to just the practice exams for Step 1.
(1) The Comprehensive Self-Assessments assist students in evaluating their degree of readiness to take the USMLE Step 1, Step 2 Clinical Knowledge, and Step 3 examinations.

Comprehensive Basic Science

Uses multiple-choice items based on information typically covered during basic science medical education courses
Content resembles that of the USMLE Step 1

Comprehensive Clinical Science

Uses information typically covered in clinical encounters
Content resembles that of the USMLE Step 3

(2) The Clinical Mastery Series assesses an examinee’s understanding and baseline knowledge of the clinical sciences and readiness for the clinical science Subject Exams.

Clinical Neurology
Emergency Medicine
Family Medicine
Medicine
Obstetrics and Gynecology
Pediatrics
Psychiatry
Surgery

(3) The IFOM Clinical Science Self-Assessment are indicators of readiness to take the International Foundations of Medicine Clinical Science Exam.

It is created with the same content specifications as the IFOM Clinical Science Examination which is primarily for medical students in pursuit of assessing their knowledge on the clinical sciences before taking their exam.

Comprehensive Basic Science

Uses multiple-choice items based on information typically covered during basic science medical education courses
Content resembles that of the USMLE Step 1

Comprehensive Clinical Science

Uses information typically covered in clinical encounters
Content resembles that of the USMLE Step 3

(2) The Clinical Mastery Series assesses an examinee’s understanding and baseline knowledge of the clinical sciences and readiness for the clinical science Subject Exams.

Clinical Neurology
Emergency Medicine
Family Medicine
Medicine
Obstetrics and Gynecology
Pediatrics
Psychiatry
Surgery

(3) The IFOM Clinical Science Self-Assessment are indicators of readiness to take the International Foundations of Medicine Clinical Science Exam.

The NBME Practice Exams for Step 1 are released by the same body that administers Step 1. This should give anyone a good idea of how accurate the questions are presented in these practice exams to the contents of Step 1.

Someone who may not be well-off may just brush the NBME Practice Exams since it could not sit well with their budget. I understand that. I mean, not everyone’s financial situation is the same.

You could always resort to practice exams that you have randomly seen on the Internet and download it for free. However, there’s no assurance that content on these practice exams came with the rights to reproduce it online. Neither would it have questions that reflect the questions released by the most recent Step 1.

Not investing for your Step 1 is dangerous and may cost your Step 1 score – which in turn harms your applications to residency programs. The $60 wouldn’t hurt if all you want is to be a licensed physician. Take this risk, you might regret not doing so once you see a below satisfactory Step 1 score.

You first have to create a MyNBME account through their NBME Services Portal. Once into the system, click the PURCHASE tab to be seen at the top portion of the page.

The next step couldn’t be any simpler. Proceed to choose which exam you are studying for. Seeing how you have made your way to this post, choose the NBME Practice Exams. However, you may have a hard time navigating the page since the names of the self-assessments are kind of perplexed.

To avoid confusion, here are the equivalent names of the practice exams for each step of the USMLE.

Comprehensive Basic Science Self-Assessment (CBSSA) – Step 1
Comprehensive Clinical Science Self-Assessment (CCSSA) – Step 2
Comprehensive Clinical Medicine Self-Assessment (CCMSA) – Step 3

How Long Are NBME Practice Exams?

These self-assessment NBME Practice Exams are shorter than the actual Step 1. Step 1 consists of 7 blocks with 40 questions per block with 1 hour allotted each. There are a total of 280 questions.

The NBME Practice Exams, on the other hand, are longer. There are 4 blocks in total, 200 questions each with a time allotment of 1 hour and 15 minutes.

If you want to simulate the USMLE as much as possible, the UWSAs (USMLE World Self-Assessment) are the way to go. The practice exams are taken within 8 – 9 hours, with breaks provided.

However, UWSAs tend to overestimate one’s score as compared to NBME Practice Exams which have a high percentage of accurately predicting your Step 1 score.

I’d suggest you simulate an 8 to 9-hour exam with the UWSAs first, then proceed with NBME Practice Exams as an indicator of an estimated prediction of your score.

How Many NBME Step 1 Practice Exams Are There?

There are 6 NBME Step 1 Self-Assessments exams which come in forms 18, 20, 21, 22, 23, 24. You may have noticed the numbers are not consecutive and could come off a bit confusing.

For several years before these forms were released, there were also 6 forms available except that they were forms 13, 15, 16, 17, 18, 19. These forms were retired by the NBME on March 25^th, 2019 with an exception to form 18.

The usual pattern observed in the release and retirement of forms tends to be in the early of March, and they usually just retire one form then replace it with another one. However, it was the first time in many years that NBME has retired so many forms all at once.

It is for this reason that when using the NBME Practice Exams for Step 1, med students are advised to start with the lowest numbered forms. NBME is observed to first retire the lowest-numbered forms rather than the succeeding numbered forms.

In other words, these forms are updated and always in line with the latest released version of Step 1. Since this is the case, there is no use for you to access older forms of the NBME Practice Exams.

Even those who did very well on their Step 1 found no reason to scavenge these forms. These provide only little additional value, in my experience.

Free NBME Self-Assessments Available Starting April 3, 2020

Speaking of retired forms, it looks like the NBME has made the NBME Practice Exams available for free starting April 3 through May 31. This is mainly due to the possibility of testing delays due to the COVID-19 pandemic.

The free self-assessment exams are as follows and can be accessed in their MyNMBE portal:

Tips For Using NBME Practice Exams For Step 1

How Many NBME Practice Exams Should I Take?

It is most optimal and recommended to complete 4 NBME Practice Exams at a minimum. But of course, it’d be of much more advantageous for you to complete all the available forms if you have enough time.

A lot of my students ask me if 6 weeks before Step 1 would be enough time to complete all forms of the NBME Practice Exams. Yes, this would be enough – but you would be rushed.

Remember, the purpose of these NBME Practice Exams is for you to create a baseline and use this to assess your progress. In order to have some significant progress, two weeks would be the optimal time allotment for you to study in between NBME Practice Exams.

Study your class notes, review your resources, and your First Aid. Review your answers and try to derive why the answer is like that. You will never have such progress from practice exams to practice exams if you rush yourself.

It’s most advisable for you to start with your NBME Practice Exams as early as possible to achieve progress on the increase of your score over time.

FYI: Self-assessments are the way to go for your Step 1. However, studying for Step 1 is all in vain if you don’t have a step-by-step walkthrough to guide you.

Is It Better To Do NBME Self-Paced Vs Standard-Paced?

You can either take your NBME Practice Exams in two different testing conditions: a standard-pace or a self-pace. To further differentiate, let’s take a look at the table below as provided by NBME.

	Standard-Paced	Self-Paced
CBSSA	Four sections, 50 items each. Up to 65 minutes to complete each section.	Four sections, 50 items each. Up to 4 hours, 20 minutes to complete each section.
CCSSA	Four sections, 46 items each. Up to 63 minutes to complete each section.	Four sections, 46 items each. Up to 4 hours, 12 minutes to complete each section.
CCMSA	Five sections, 36 items each. Up to 45 minutes to complete each section.	Five sections, 36 items each. Up to 3 hours to complete each section.
CS Mastery	One section, 50 items each. Up to 75 minutes to complete each section.	One section, 50 items each. Up to 5 hours to complete each section.

As you can see, following the self-paced timing method allows the student to have more time in answering the practice exams. The standard-paced may look unrealistic and involves a lot of pressure, but believe me, this is the only way to approach these NBME Practice Exams.

You want to simulate a real-life Step 1 experience as much as possible. This trains you to think fast and efficiently when you’re taking Step 1.

Research on NBME Self-Assessments to project performance on USMLE Step 1 also indicates that standard paced conditions produced better estimates of future Step performance than Self-Paced ones.

What Is The Best Order For NBME Practice Exams For Step 1?

Most students will often make the mistake of taking their first NBME Practice Exams once they finished their first pass on the First Aid. They would usually postpone their first try on these self-assessments and review everything on their review resources first due to several reasons.

I would usually hear reasons like they already know their score is going to be low since they haven’t reviewed yet and that it’s going to damage their confidence, so what’s even the point? This may be reasonable, but let me refute this in the most straightforward way possible.

You have to take your first NBME Practice Exams before your first pass on First Aid or UWorld. This enables you to create a baseline that you will use to assess your progress. It also points out your weaknesses and strengths which in turn helps you create an effective and bullet-proof study plan.

When it comes to the forms, there is no specific order in taking the NBME Practice Exams that guarantees the best way to utilize it.

It wouldn’t matter which form you would take first because each exam has its own scale. However, considering how the NBME always retires the lowest-numbered forms first – the only way to approach this is to always start with the lower numbered forms.

Again, there’s no evidence that this is the best way to utilize these self-assessments. You just don’t want a form to retire on you when you’re just about to start taking your NBME Practice Exams.

Where Can I Find NBME Answers And Explanations?

Thing is, NBME provides you with answers to the questions you got wrong. But here’s the catch – you won’t be getting explanations as to how the answer was derived.

This is even generous on the side of NBME since previously, they will only tell students which questions they got wrong. It was ineffective for not providing the right answers because after all, it’s still a resource for students to rely on so that they could improve their score for Step 1.

Thankfully, they have given out more and more information over the years, but this is just how good as it gets. Most of the time you’re going to have to rely on your First Aid and other review resources to derive an explanation to your answers.

As much as possible, refrain from checking online message boards since the explanations there are not verified by experts and could possibly misinform you. There’s nothing worse than answering your Step 1 with a wrong understanding of the concepts involved in the questions.

Finding explanations for every answer will most likely be consuming all of your time. It wouldn’t be advisable to review every answer since your time could be used to try other practice exams.

But if you do decide to understand how the answers are derived, just make sure to set a time limit for yourself to ensure that you won’t be running out of time.

On the other hand, on April 2, 2020, NBME has now included explanations for NBME Self-Assessments on Medicine forms 5 and 6 of the Clinical Mastery Series. NBME has also assured that students can look forward to answer explanations on additional and upcoming Self-Assessment forms later this 2020.

Frequently Asked Questions On NBME Practice Exams

How Accurate Are NBME Practice Exams?

One reason to have faith in the NBME Practice Exams is that they are released by the same body that administers Step 1. Plus, researchers have proved that there’s a relationship between performance on the NBME Comprehensive Basic Sciences Self-Assessment and USMLE Step 1.

The CBSSA explained 67% of the variation in Step 1 scores. To better comprehend this, let’s take a look at the charts below provided by the National Board of Medical Examiners (NMBE).

Actual Step 1 Scores Minus Score Predicted by NBME Within 1 Week of Exam

As we can see from the chart above, most of the actual Step 1 scores minus the score predicted by NBME within 1 week of exam are within the rage of 0 to 9.

This implies that the score in your last NBME within 1 week of exam will most likely be the score on your Step 1 and could increase by a chance of 68%, and decrease by a chance of 32%.

You could also see that the next high ranking frequency groups are still relatively significant. This could mean that NBME still has the tendency, to underestimate (by a chance of 31%) and overestimate (by a chance of 9%) your scores by +/- 9.

However, an increase or decrease of 20 or more points is quite uncommon and rare, with estimated chances of 7% and 3% respectively.

Nevertheless, results in these researches prove that NBME self-assessment examinations serve as an accurate and realistic basis for predicting performance on particular Step exams with a bit variation in predictive accuracy across provided test administration conditions.

FYI: Studying for Step 1 with NBME Practice Exams is great but you also need the right guide to walk you through the process.

What Is A Good NBME Score?

One would usually make the mistake of only taking the NBME Practice Exams only once and never again. Let’s assume that this student scored 230. Is this good? Well, nobody knows.

You see, the purpose of taking these practice exams is to assess your progress. Therefore, you need to establish a baseline for comparison. If you only have this one score, how are you ought to know if you are ready enough to take Step 1?

Let’s skip the scenario to 2 weeks after and this student changes his mind and decides to take another NBME. Then, he scored 250. Now, we can assess and conclude that he had improved a lot.

Hence, a good NBME score will always depend on whether you had improved from your previous try on a practice exam. These NBME Practice Exams are a self-assessment and progress tracker, after all.

We understand that sometimes, students build a well-thought study plan when it comes to their NBME Practice Exams, but some tend to withdraw from this schedule along the way due to personal reasons and put it aside for the time being.

In this case, you might be wondering when would be the best time for you to resume your NBME Practice Exams. If so, you must have already taken a lot of NBME Practice Exams before.

It’s not advisable to repeat old NBME Practice Exams. Just make sure to review your answers and the concepts involved in the questions to retain information.

Thus, once you resume, it would be best for you to space out the remaining NBME Practice Exams in your archives accordingly to make sure you don’t run out of forms months before your Step 1.

Can You Retake NBME Exams?

The majority would think that you have to repeat your NBME exams in order to retain the answers. Not going to lie, when I was studying for Step 1 with the NBME Practice Exams, I thought the same. However, my tutor advised me to do the opposite.

In fact, it’s best for you to never take an NBME Practice Exam more than once.

Okay, wait. You might be confused and exclaiming “Earlier on you said that NBME Practice Exams should establish a baseline and track my progress by taking these exams on an interval, and now you want me to never take a practice exam more than once? Am I the only one not getting how this is going?”

Well, in general, you should take different NBME Practice Exams for the purpose of tracking progress and validating the predictive power of these self-assessments. This strategy also enables you to review your wrong answers between the tests you take on an interval. Thus, there is progress.

My point being – taking the same form of an NBME self-assessment will reduce its predictive power. Recalling the questions while understanding and mastering the concept behind it will do you much better and could even increase your score.

Are New NBMEs Predictive?

There would be no reason for the newly released NBME Practice Exams to not be predictive since NBME always releases new forms and retires old forms to remain aligned to the latest version of Step 1. Hence, its predictive power will remain as they were in the retired forms.

That’s it for the ultimate guide on NBME Practice Exams for Step 1! I hope you found this post informative and helpful to make sure you use your self-assessments in the best way possible.

We give credit to Yousmle, Med School Tutors, and USMLE Pro which served as sources for this blog post. Charts, announcements, and other information were derived from the official NBME website. Check it out for more updates.